What is the difference between an HMO and a PPO?
Health Maintenance Organizations (HMO’s) require a patient to select a primary care physician to coordinate his or her care. Most HMO’s provide care through a network of hospitals, doctors and other medical professionals, that as a patient, you must use to be covered for that service. Preferred Provider Organizations (PPO’s) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize health care provider within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.
A Health Maintenance Organization, HMO, is an insurance company who manages your health benefits through a negotiated physician and hospital provider network and comprehensive care management programs. A Preferred Provider Organization, PPO, is not an insurance company per se, but works with your existing insurance plan to offer higher sets of health care benefits when you utilize a selected network of physicians and hospitals. PPOs work with multiple insurance plans, self-funded employers, health and welfare trust funds, and business coalitions.
