HMO vs. PPO – Health Maintenance and Preferred Provider Organizations

You should familiarize yourself with the different types of health plans available to you.  They are not all the same.  Most people want to have a PPO (Preferred Provider Organization) because it allows the most flexibility and control over your health care providers.  Another option is an HMO (Health Maintenance Organization) and those plans are typically smaller and limited to a geographic area.  You typically have a primary care doctor that makes all decisions including if they feel you need to see a specialist.  You do not really have much say in the process.  There are other options, too, that are smaller and even more limiting like EPO’s and POS’s.  You may find that with HMO’s, EPO’s, or POS’s that you have very limited or no coverage at all when attempting to access care outside of their network.

If you travel for work or pleasure, you may want to consider a Nationwide PPO instead of the limited networks like HMO’s, EPO’s, and POS’s.

Is My Doctor Considered “In Network”?

If you really like your current doctors and want to continue to use them, you should call your doctor’s office and see if they take your new health coverage.  Or you can look at the health insurance company’s provider page and/or your doctor’s website to see if they are in-network with the health insurance carrier.

This is especially important if the health plan is an HMO because HMO’s typically have limited to no coverage if you use a doctor outside of your network.