HMOs and PPOs are the two most common health plans available these days. Most of the Americans having health insurance through their employer are enrolled in these types of care plans. PPO and HMO are two most famous managed health plans in the U.S. for employees. Both can be affordable and offer access to high-quality care. However, they do have some differences which can be explained as follows:
A Health Maintenance Organization (HMO) requires the employer to provide the employees with medical facilities comprising hospitals, doctors, and clinics with all the necessities. It contracts with health care professionals to create a 'provider network'. In this plan, the employees will have a chosen physician who will provide a personal doctor as well as all basic medical services. If you select HMO insurance, you'll pay a small amount if you visit a hospital or physician within the plan network. If an employee needs a specialist, then the physician will have to refer to the specialist present within the network and the bill is paid by the employer. However, if the employee wants to consult a specialist out-of-network, then he is responsible for the bill.
A Preferred Provider Organization (PPO) is a health plan which has contract with a network of 'preferred' providers. It consists of a network of specialists as well as General Physicians. With the PPO, you get an opportunity to select your preferred doctor. If you receive the care from the health provider in the preferred network, you will be only responsible for the predetermined annual deductible from the bill. However, if you choose a physician, doctor or hospital that is not in the preferred network, you will have to pay a higher amount and then put a request reimbursement under PPO.
In short, under both the plans, the employer is responsible for the employees health cover. They not only cover their employees but also the immediate family. Most of the times, employees prefer PPO due to the liberty to consult a doctor of their choice. However, choosing a right plan depends on your unique needs and when it comes to sorting out those, there's no substitute for the expert advice from an insurance agent. So, while deciding which plan is right for you, take advice from your insurance agent. He/she will help you to find a plan that works for your health needs and on budget at the same time.
