What is the difference between an "HMO" & an "PPO"?, Which is better?

Answer 1

HMO refers to "health management organization". It's made up of a group of professionals (doctors,therapists) who agree to work for specified fees. HMOs are valued because they are low-cost: the professionals work for fees that are lower than they can get elsewhere; but they have regular patients from large insurance companies and from the other professionals in the group who refer to each other (e.g., a general practitioner will refer a patient to a specialist in the HMO group). The cost-effectiveness benefits the patients as well since the copayment is usually quite low ($5 - $10 is what I pay per visit and per Rx). Problems can include many rules (must see your regular physician before being referred to a specialist, e.g.), long waits for appointments, and restricting access to specialized services--in my experience, though, if you ask, the doctors will give you what you want; however, you have to be an educated patient and know what to ask for (e.g., particular tests or treatments) and you may need to back up your request with rational arguments for why these tests, procedures, etc. are a good idea for you.

A PPO refers to a Preferred Provider Organization, and like HMOs, they agree to service particular patients with specific insurance companies. A PPO is made up of a diverse group of professionals who, like those in the HMO, refer to one another. One big difference is that the PPO has less rules than the HMO--you don't need to see your regular physician for a referral to a specialist; you just need to phone any specialist of your choice for an appt., and if you choose a specialist in the PPO group, it costs you less. The PPO is more expensive than the HMO--co-payments are higher, you will have lab fees that add up to quite a bit of money, and your insurance premiums are also higher. The PPO will give you much more freedom in the doctor(s) you see as well as the treatments you are able to get. In my experience when I had a PPO, waiting to see the doctor was never an issue--the doctor often took me the same day I phoned, even when it was just a routine visit.

If money is an issue, the HMO is the best choice. If having the freedom to be treated by whom you wish and having a choice of treatment options is important to you and money is not an issue, then go with the PPO.

I have had both: I preferred the PPO; but I am with an HMO by choice because I like saving my money and can argue a good case to my HMO doctor when I need different treatment options and/or specific tests (100% success rate in getting what I want so far). Hope this was helpful--all the best to you!

Answer 2

An HMO is an insurance plan that you choose a physician from a list of ones on their program. A PPO is an ins. plan where you can choose your own dr. One of the differences is that PPOs have a higher co-pay. But some people have had the same dr. for years & don't want to change.

Answer 3

HMO - Health Management Organization vs PPO - I think it's Preferred Provider Organization. I think with HMOs you are at the mercy of the plan - and tho PPOs cost more, you have a lot more say about who you go to and where you go for treatment, and how often.

Answer 4

at my work it's a much better deal and less expensive to have an hmo. The deductibles are lower.. the cost for the coverage is less.. I'm able to pick my own primary care physician.. The PPO sounded like a rip off when I sat down and actually studied the costs versus the care.

Answer 5

Basically an HMO gives you a list of the doctors you have to chose from. Your doctor may not be on the list. Plus, with an HMO doctor it is much harder to get referred to a specialist. HMO's want your regular family practice doctor to attempt brain surgery before they have to pay a specialist to do it.

PPO - you get to choose your own doctor, and doctors can refer you to a specialist much easier.

PPO's are usually more expensive then HMO's, because the quality of service is MUCH better.