10 Significant Differences Between HMO And PPO


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10 Significant Differences Between HMO And PPO.

Difference Between HMO And PPO:  The American health care system requires citizens to be a part of an insurance scheme that covers their medical expenses. Maintenance Organization (HMO) and the Preferred Provider Organization (PPO) are two of the most common health insurance plan in the US.

The main difference between HMO and PPO is that HMO covers care provided by paramedical staff and hospitals inside its network. PPP covers the healthcare services provided both inside and outside the plans of the PPO provider network.


Preferred Provider Organization (PPO)

A Preferred Provider Organization (PPO) provides financial incentives for patients also provides them coverage for services rendered by health care providers who are not part of the PPO network.

There Basic preventive care (e.g., checkups, physicals), emergencies, maternity care, surgeries, and treatment from specialists. With a PPO plan, you get access to a network where a fee schedule has been worked out in advance.

A PPO is more flexible than an outmoded HMO insurance plan. You don’t need a primary care physician. You can go to any health care professional inside or outside of your network. If however, the employee chooses a physician from outside the preferred network then the employee will be liable to pay a higher amount and then put a request under PPO for a reimbursement.

Maintenance Organization (HMO)

HMO stands for Health Maintenance Organization which requires the employer to provide the employees with a medical network that will comprise of doctors, hospitals and clinics equipped with all the necessary facilities.

The employees will have an assigned Physician who will provide the services of a personal doctor and all basic medical services. In the event that an employee requires a specialist, then the Physician will have to refer the patient to a specialist present within the network.

In this case, the medical bill is handled by the employer. If however, the employee wishes to consult a specialist outside of the network, then the employee is responsible for the bill.

Differences Between HMO And PPO

1. In HMO all the healthcare services of clients will be coordinated between the client and his designated PCP. PPO plans provide the flexibility to the clients as the client is not required to have a PCP. The client can receive treatment from any doctor he wants, however, he will be able to save low.

2. A referral is needed in HMO if you want to take care of a specialist while PPP plans do not require you to get a referral in order to visit a specialist.

3. In the case of HMO, the client is not required to file a claim as HMO only allow to take the services of healthcare that are in the network of HMO. While claims are required to be filed in some cases of PPO when the client take the services of a specialist outside the network of PPO.

4. HMO covers care provided by paramedical staff and hospitals inside its network. PPP covers the healthcare services provided both inside and outside the plans of PPO provider network.

5. HMO have mostly no deductibles and have low co-payments as well. PPO plans require payment of annual amounts and the deductible amounts will be in addition to any co-payment.

6. However, the PPO plans are more flexible as compare to other healthcare plans but the fact is that HMO plans are less expensive as compare to other healthcare management providers.

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EDU Team.

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