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HMO vs PPO
Jeannie Demmer • February 7, 2025
HMO vs PPO Network! Which is Best for You?
Here's a breakdown of HMO and PPO healthcare coverage, highlighting their key differences to help you choose the best plan for your needs:
HMO (Health Maintenance Organization)
HMOs have a limited network of doctors, hospitals, and healthcare providers. You'll need to select a primary care physician (PCP) within the network who coordinates your care and provides referrals to specialists.
Cost:
HMOs typically have lower monthly premiums and out-of-pocket costs compared to PPOs.
Flexibility:
HMOs offer less flexibility. You generally need a referral from your PCP to see a specialist, and out-of-network care is usually not covered except in emergencies.
PPO (Preferred Provider Organization)
PPOs have a larger network of providers, giving you more choices. You can see specialists without a referral and have the option to seek out-of-network care.
Cost:
PPOs usually have higher monthly premiums and out-of-pocket costs compared to HMOs.
Flexibility: PPOs offer more flexibility. You can see specialists without a referral and have the option to seek out-of-network care, although you'll typically pay more for it.
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