Difference between HMO and PPO

Both of these relate to health insurance and in case you are wondering, health insurance is an essential requirement as it can help provide for essential medical treatment just when you need it the most. So it makes sense to learn more about these and how they apply and what’s the key difference between both.

Difference between HMO and PPO

Chances are that you already have some form of health insurance already, and may be looking for something better. Or you are thinking of applying for one, given the current risks that are part of the daily life and would like to have access to premium medical facilities and treatments. In either case, do read on to know more about the key differences between HMO and PPO

Essentially, when you are shopping for health insurance plans, you would spot the differences between many since no single health insurance plan is like the other. But the key difference would be as to whether the plan in question is HMO or PPO.


HMO plan is essentially where you get to pick on physician as your primary healthcare physician, more of a point person to attend to all your health needs and you would have to consult him for all your medical conditions in order to avail the benefits of the insurance plan. This is essentially what HMO is all about – you would have to consult your primary health care physician to attend to all your medical needs, and the same will be covered under HMO.

While you are not expected to consult any other health care professional, under the HMO, you can do so if your primary care physician is not available for one reason or the other. Additionally, you can consult other doctors in case of an emergency and expect coverage under HMO as long as it is an emergency. The only other exception to HMO is that women can consult Gynecologists for regular checkups and still claim coverage under HMO.

For example, let’s say that you have developed a skin rash and opted to consult a dermatologist who is not listed as your primary care physician. In which case, your HMO plan will not kick in, since you are consulting someone else who is not listed as your primary care physician. Instead, this is what you should have done to avail the benefits of the HMO plan. You should have first consulted your primary care physician; he would examine you and then refer to one of his colleagues who specialize in Dermatology.  All referrals done by the primary care physician will still get coverage under the HMO plan so you should still be able to avail full benefits of the same.


A PPO plan offers you more flexibility and does not restrict you from consulting other medical professionals. All you have to do is to stay within your network and you should be able to consult any medical doctors for effective treatment for your current condition. The only flip side to this is that PPO often does not provide for complete coverage for a variety of reasons and some of the treatments are not covered either.

So you may want to research more, consult others before signing up on the dotted line.  And the other thing is that a PPO often leads to higher costs, for a variety of reasons which is why it is not that highly recommended. But it does come with an inbuilt flexibility which should work to your advantage since you can consult any doctor to help treat your current condition.  With a PPO, you would be required to stay within your network, and as long as you do that, you should be able to avail full coverage, and fewer co-op costs

Both the HMO and PPO are good health insurance plans with a few key differences; if you already have a primary health care physician then you may want to opt for the HMO plan. An HMO plan results in less paperwork, faster response and since you already have a primary care physician who is aware of your health profile, a faster diagnosis, and effective treatment. These are some of the key differences between both plans, and you should undertake some additional research before making an informed decision as to which one you would prefer to join. Both the plans come with its own advantages and disadvantages, just review both and then consider your current requirements, find out if all the health conditions are covered by these plans and then choose one that seems to be a good fit,

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