Health Insurance

Difference Between HMO and PPO – Which to Choose

It is important to know the difference between HMO and PPO before you decide which coverage to use. It is not simply about deciding to get health insurance coverage and about getting the lowest rate. There is a little research to be done and get the findings organized to choose the health insurance plan that is best for you.

There are two types of affordable care plans, namely the HMOs and PPOs.

HMOs (Health Maintenance Organization)
HMO is an organization of healthcare providers (e.g. doctors and hospitals) that have contracted with an insurance company to offer their services at a fixed price.

HMO plans are normally quite restrictive and with lots of rules. You will be asked to select a primary care physician, who handles all aspects of your healthcare. The primary care physician must be a member of the HMO. This means that if you are currently seeing one who is not in the network, you will need to change doctors. In the event that you need to see a specialist, it is your primary care physician who will do the referral.

Personal Medical Insurance and Prescription Assistance Programs

Personal medical insurance provides benefits for medical care. Some policies may provide for payment of medical expenses incurred on a reimbursement basis by paying benefits to the policy owner, payment on a service basis by paying those who provide the services directly, or payment of an indemnity by paying a set amount regardless of the amount charged for medical expenses. Medical expense or hospitalization insurance may be written on an individual or group basis.

Although there are many types of benefits available, personal medical expense insurance can generally be categorized as basic medical expense insurance, major medical insurance, comprehensive medical insurance, and special policies. Most of these plans have largely been replaced by managed care alternatives and are no longer sold as stand-alone plans. These types of plans have been modified and replaced in response to changes in the health care field relative to cost containment and market competition.