Q:

Which is better, an HMO or a PPO?

A:

Quick Answer

A PPO is better than an HMO in terms of flexibility, but an HMO is better than a PPO in terms of cost. HMOs, or health maintenance organizations, are coordinated through a single doctor, whereas PPOs, or preferred provider organizations, allow patients to visit any health care professional.

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Full Answer

A person enrolled in an HMO plan must select a single primary care physician. All health care services go through that doctor. A referral is necessary if the person wishes to see any other health care professional, and visits to health care professionals outside the network are not covered by the plan.

However, there are certain exceptions, including emergencies. Another typical exception is routine service visits to see an obstetrician/gynecologist within the network for routine services, such as Pap tests and obstetrical care.

PPO plans allow people to go to whatever health care professional they wish without a referral. This includes professionals both inside and outside the network. However, remaining inside the network ensures full coverage and means less out-of-pocket costs.

Coordinating care through a single doctor means there is less paperwork and lower health care costs associated with HMOs. But for people who want to see particular specialists, PPOs are the better option.

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