Whats the difference between PPO and an HMO?

Question

Im a 22 year old male and am buying health insurance for the first time on my own, what should I do?

Answer 1

Hey there. I am a 22yr old female and I work in the insurance business and I myself just obtained health insurance for the first time. PPO is MUCH MUCH better as you can go to almost any doctor you want in the book you will receive with your policy. You can also go to any type of doctor, say like a Podiatrist, Bone Disease Doctor etc. Your co-pays tend to be a little bit more but it is a better deal in the long run as with an HMO if you ever have to go to a specialist doctor you would have to go to your main doctor, (pay the co-pay there), then get a referral to go to the specialist doctor, (podiatrist, bone disease, throat doctor etc), then you would end up paying another co-pay there as well. Go with an HMO!!! Any other questions feel free to email me!

Answer 2

The biggest difference to YOU as the insured is this: When you select an HMO, your insurance payments are generally cheaper but your medical care is less effective; i.e., the doctor is not free to provide you the treatment that HE deems fit; he can only offer you the treatment that the HMO will allow. In fact, about 10, 12 years ago there was a lawsuit brought by the family of a deceased woman against the HMO for wrongful death because the HMO denied the woman a life saving procedure because the HMO deemed it "experimental" and "too expensive." The jury saw it differently and awarded the family $70 million. It was a landmark case, but things in the HMO world have not gotten much better since.

With an HMO you also must see your GP ($15 - $25) to get a referral to a specialist ($20 - $35) and you have to go to the doctor that the HMO selects for you, whether you like him or not.

A PPO has a much wider range of doctors that you can choose from, you don't necessarily need to have a referral to go directly to a specialist, and most importantly, the doctors do not have to answer to the insurance company to get approval for treating you.

There is a co-pay for doctor's visits just like an HMO, and they are about the same, you just get a lot more options with a PPO than an HMO. There is also no yearly deductible that you must meet before the insurance kicks in. The monthly payments to a PPO are slightly more expensive than an HMO, but it really is negligable. For real live benefits, a PPO is the best way to go.

Good luck with this!

Answer 3

As a 22 year old male assuming you most likely don't have any pre-existing conditions it would be advisable to look into obtaining a PPO plan. While PPO plans can have high deductibles depending on where you live and what plans are available in your state some PPO plans can have a flat dollar copayment for doctor visits ie $35 copayment. This is what is called a first dollar benefit where you don't have to pay towards your deductible first before using that benefit. Also, PPO plans are 2 tiered plans (Tier 1 - PPO network, Tier 2 - Non-PPO network). The richest benefits apply (Tier 1) if you use the carrier's preferred provider directory to find a doctor. You can use a doctor not on the directory (TIer 2) however your benefits will not be as rich. With PPO plans you can have direct access to a specialist and do not need a referral from your primary doctor.

HMO plans on the other hand offer more extensive first dollar benefits however they also offer more expensive premiums as well!! :) With an HMO plan you must select an HMO primary care physician from the carrier's HMO physician directory. You must see this physician for all treatment. If you need to see a specialist you must first see your primary care physican to obtain a referral. And then your PCP must refer you to a specialist within their HMO medical group. In other words, your PCP would not be allowed to refer you to a specialist across town.

I would advise asking around for a good health insurance broker's office. I have worked for a health insurance broker for almost 5 years. Broker's represent all carriers and work for you, the client. While broker's do get paid commissions by the carriers for your plan it does not cost you anything to work with a broker nor does the cost of your plan include any broker's fees.

Hope this helps!!

Answer 4

A PPO plan lets you select the doctor or hospital you want from a list of heath care providers that are approved by the insurance company.

With a HMO, you go to their facility and get whatever doctor has the duty.

Answer 5

ppo you can go to what ever doctor you want and you pay a percentage.


hmo you go to who is on the accepted provider list with the insurance company and you have a payment of like 15 to 25 dollar a visit

Answer 6

http://www.insurance.com/FAQs/healthFAQDetail.aspx/index/7

The above link answers this question authoritatively.