Enrolled Agent-licensed to practice before the IRS, Samuel N Smith, EA, South Carolina
An HMO tends to be more restrictive than a PPO. Please understand what happens if get treatment "out of network". Do you have a "PFFS" -private fee for service" plan in your area. If so, if you are asking this question in relation to medicare the PFFS only requires you to call the doctor yuo wish to go to and ask them if they accept the PFFS plan.
An HMO describes a plan that pays it's doctors and other providers a flat fee per patient. You must choose a primary care physician and they are responsible for your care. They usually don't get to bill for their services, they have to make do with what they get. They will be your first call or visit and will manage your referrals and other care. They are usually part of a hospitals system and your inpatient care will be within that hospital system. You have less control over the providers you utilize than with a PPO.
A PPO isn't really a health insurance plan, it's a network of physicians, hospitals and other providers. Many health insurance companies may utilize a PPO to control their costs. This is a fee for service arrangement where the provider bills the company for your care and you must use the hospitals in the network to get your highest benefit level. You can usually chose your doctors and hospitals and you have more control than with an HMO. The health insurance companies save money by using a PPO because the providers have to agree to get paid on the PPO's fee schedule to gain access to the patients.
Historically, and HMO is less expensive than a plan using a PPO. This is because the HMO has more control over your care and they also have more control over a providers compensation. This is really a question of preference. If you're OK with the HMO dictating where you go and who you see for your care, this would be a great option for you and you'll probably save some money. However, If you'd like to be the one to choose who you see for your care, you'd probably be more comfortable with a PPO arrangement. Just realize that you'll probably have to pay a little more for that freedom.
Agent Owner, Gilmore Insurance Services, Marysville, Washington State
Which is best an HMO or PPO? Actually as far as health care goes, both are very similar. Both offer the benefits laid out by law of your state, or currently what the Federal Government requires. The difference comes down to how they are used for services. A Health Maintenance Organization (HMO) uses what is commonly called a gatekeeper system. A gatekeeper is a primary care doctor who the insured works with first and referrals are generated by this primary care doctor. If you use an HMO system you will direct your care through this gatekeeper.
A Preferred Provider Organization (PPO) is a network of doctors and specialists who have contracted with a medical plan to provide services to members of that plan. A PPO offers SELF DIRECTED choices for the insured. The insured decides whom they wish to see. If they want to see a specialist, they call the specialist and set up the appointment themselves.
Which is better? Depends entirely on who is using their plans and what they want from a plan.
Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada
This varies from person to person and many factors can go into it such as personal preference, where you live, do you travel, and premium tolerance, just to name a few. PPO networks are much larger than HMO networks - HMO networks feature a more restricted network and you can pay higher costs for going to out-of-network doctors. The premiums for PPO plans will generally be higher because of this. If you can afford a higher premium, you may want to go the PPO route. If you have a very tight budget and you need to keep your premiums to a much lower figure, an HMO may be more suitable.
Also, you may not have many options for health insurance in some areas. You're generally going to have more options living in an urban area than a very rural one - not every carrier will offer every network type either under the new affordable care act.
This is really a matter of personal preference. While the lower cost associated with HMO plans can certainly be appealing, anyone with an HMO only has coverage when they are using a medical provider in their network. If having your choice of doctor is important to you, and your chosen physician does not work with an HMO, or if you travel extensively and may need coverage away from your home area, then you will more than likely find the additional cost of a PPO to be very worthwhile.
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An HMO describes a plan that pays it's doctors and other providers a flat fee per patient. You must choose a primary care physician and they are responsible for your care. They usually don't get to bill for their services, they have to make do with what they get. They will be your first call or visit and will manage your referrals and other care. They are usually part of a hospitals system and your inpatient care will be within that hospital system. You have less control over the providers you utilize than with a PPO.
A PPO isn't really a health insurance plan, it's a network of physicians, hospitals and other providers. Many health insurance companies may utilize a PPO to control their costs. This is a fee for service arrangement where the provider bills the company for your care and you must use the hospitals in the network to get your highest benefit level. You can usually chose your doctors and hospitals and you have more control than with an HMO. The health insurance companies save money by using a PPO because the providers have to agree to get paid on the PPO's fee schedule to gain access to the patients.
Historically, and HMO is less expensive than a plan using a PPO. This is because the HMO has more control over your care and they also have more control over a providers compensation. This is really a question of preference. If you're OK with the HMO dictating where you go and who you see for your care, this would be a great option for you and you'll probably save some money. However, If you'd like to be the one to choose who you see for your care, you'd probably be more comfortable with a PPO arrangement. Just realize that you'll probably have to pay a little more for that freedom.
A Preferred Provider Organization (PPO) is a network of doctors and specialists who have contracted with a medical plan to provide services to members of that plan. A PPO offers SELF DIRECTED choices for the insured. The insured decides whom they wish to see. If they want to see a specialist, they call the specialist and set up the appointment themselves.
Which is better? Depends entirely on who is using their plans and what they want from a plan.
Also, you may not have many options for health insurance in some areas. You're generally going to have more options living in an urban area than a very rural one - not every carrier will offer every network type either under the new affordable care act.