What is the Difference Between PPO and HMO?

PPO Plan:

A PPO plan offers a network of providers, but you are not restrained to only seeing those providers. However, seeing a network provider may result in a lower co-pay.

  • You can see any doctor or specialist you want.
  • Your hospital bills outside of your network will be covered. 
  • Premiums are usually higher than those of HMO plans.

HMO Plan:

An HMO plan allows you to see doctors and hospitals within their network. Your medical bills are only covered if you see doctors or specialists within the network. There are several restrictions to an HMO plan "such as allowing only a certain number of visits, tests, or treatments."

  • With certain HMO plans, you will need to see a primary care physician (PCP) when determining your next step in treatment.
  • You will need a PCP referral to obtain coverage when visiting a specialist or when receiving a special test.
  • You will not receive coverage for medical visits outside your network.
  • Premiums are typically lower for HMO plans vs. PPO plans.