What Are the Differences Between PPO & HMO Insurances?

understand the advantages & disadvantages of different insurance plans

One of the big decisions every American must make is what type of health insurance to select that best meets their health needs, allows them to see their preferred doctors, and is within their budget. the two main options are ppo and hmo insurance plans. “ppo” stands for “preferred provider organization” and “hmo” stands for “health maintenance organization”. but what do they mean?

Although there is no clear answer as to which insurance works for everyone, there are clear advantages and disadvantages to each type of insurance plan that can guide you in making the decision that best suits your needs.

Reading: What does hmo insurance mean

what is an hmo insurance plan?

hmo insurance gives policyholders access to specific doctors and hospitals within the network that it allows you to see, and your medical bills are only covered if you see providers within that network. Although this limits your choices of providers you can see, you will still need a primary care physician to refer you to specialists within your HMO network. Many choose an HMO insurance plan simply because the monthly premium is lower than PPOS and the out-of-pocket costs are lower. It’s worth noting that you’ll still be able to go to the nearest emergency room and be covered in the event of a medical emergency.

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HMO insurance plans generally require prior authorizations for services.

what is a ppo insurance plan?

PPO plans give you much more flexibility in deciding which health care providers you can see and be covered for, but care is often more affordable if you stay within the network of providers your policy covers. You will not need a referral from a primary care physician to a specialist; rather, you can make an appointment with a specialist doctor on your own, including out-of-network specialists (although you’ll usually pay more out of pocket for out-of-network specialists). Some decide that PPO is not the best option because monthly premiums are typically higher and out-of-pocket costs are higher. You may also feel that the responsibility of managing your care without the help of a primary care physician (if you choose not to have one) is too great a burden.

should i get an hmo or ppo plan?

As you weigh your options between enrolling in an hmo or ppo plan, many people like you have the same question: which is the right option for you or your family? The main question you’ll need to ask yourself is whether cost or flexibility is more important to you.

The main differences between hmo and ppo plans are:

  • cost: hmos have lower monthly premiums, lower out-of-pocket costs, and sometimes no deductible (a set dollar amount you must pay out of pocket before your insurance starts paying the doctor’s bills). PPOS typically have higher monthly premiums, higher out-of-pocket costs, and have a deductible that you must meet before paying your health care bills.
  • network coverage: With an hmo plan, you can only see providers within the network, unless it is a medical emergency. PPO plans give you much more flexibility to see both in-network and out-of-network providers.
  • referrals: hmo policyholders must have a referral from their primary care physician to see an in-network specialist. With PPO plans, policyholders do not require specialist referrals and are not required to have a primary care physician.
  • insurance plans we accept at ridgecrest regional hospital

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    we accept all major ppo insurance plans and are in network with:

    • aetna
    • americas choice provider network
    • blue cross hymn
    • anthem blue cross ca exchange
    • hay street
    • blue cross (including fep)
    • blue shield
    • blue shield ca exchange
    • blue shield of ca/va
    • cigna
    • cmsp
    • main election
    • coventry/first health
    • coventry/mail handlers
    • geha
    • health network
    • medicare health network
    • medi-cal health network
    • tricare health network
    • health network toilet
    • smart health
    • interplane
    • integrated health plan
    • kern health network
    • multiplan
    • networks by design
    • peaceful
    • phcs
    • first class health services
    • three rivers
    • triowest
    • cfu
    • united health care medicare
    • united health
    • please note: we currently do not accept hmo insurance plans. however, in the event you receive care under an hmo plan in rrh, you may be required to obtain prior authorization from your hmo.

      if you qualify for free assistance from one of the many government programs, such as medi-cal, ssi, healthy families, or others, our qualified staff can help guide you through the process of seeing if you can submit health care bills using these programs. please call ahead for more information.

      For more information about insurance and billing for our hospital, click here or contact us at (760) 499-3189 to speak with a member of our staff.

      See also: 7 Tips For Talking To an Insurance Claim Adjuster