Choosing between an HMO or a PPO health insurance plan really depends on your needs. First, let’s define what each of these terms mean.

HMO (Health Maintenance Organization)

Think of an HMO system as having a manager who oversees the best for your health. First, you pick out a doctor who becomes your primary care physician (PCP). Your PCP becomes like your health care manager. He or she will guide your healthcare by referring you to specialists, sending you to have labs and tests done, and prescribing you medicine all as needed. When you’re with an HMO, you need to stick with the doctors, specialists, hospitals, pharmacies, labs and other medical support companies that are within the HMO network. If you go to a provider outside the HMO network, your medical service may not be paid for at all. And this can cost you directly. This is why in an HMO plan it is always best to consult with your PCP instead of randomly going to a doctor or other medical provider that your friend or relative told you about.

When putting medical providers into its provider network, an HMO typically looks for the quality of service that these providers offer. Typically the premiums for an HMO health insurance plan are lower than premiums for a non-HMO plan. An HMO plan can be a good way to save money.

When HMOs first began some years ago, they sometimes got a reputation for being difficult in approving medical care for their patients. This cause many people to have a negative view of the HMO process. But over the years HMO’s have improved their quality of service and now HMO’s can provide you with quality health care at affordable prices. There are many HMO plans out there. Make sure you really earn about the ones you are thinking of selecting.

PPO (Preferred Provider Organization)

PPOs are different than HMOs in that you are allowed some flexibility of what doctor you see and where you get your tests and labs done.  Although PPOs also have a provider network, you have more flexibility to see any doctor you wish. Is this important? It might not be if you don’t know how to judge what doctor you need. Often patients rely on their primary care physician to recommend a doctor. So if you don’t already have doctors or specialists who are involved in your health care, going the PPO route may not be a cost effective option for you.  However, if you need the flexibility of seeing different doctors who may not be in a typical HMO network, then a PPO may be a good fit for you.  The premiums for a PPO plan are usually higher than those of an HMO plan.  Even though you have the ability to visit any doctor you’d like, it’s best if that doctor is in the PPO network. Visits outside of the PPO network may be paid by your insurance plan, but higher contributions from you (copayments, etc.) may be expected from you. Like an HMO, there are plenty of good PPO plans out there. Make sure you choose carefully.

Either option should provide you with quality health care if you do some research. You can always get assistance by going to 1800health.com and having a licensed health insurance agent help you discuss your needs.

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