| If the Obama Health Care Reform plan goes | | | | be covered. |
| through, your health care insurance choices are | | | | Preferred Provider Organization (PPO) |
| likely to change drastically. Whether these changes | | | | A Preferred Provider Organization (PPO) is also an |
| will be good or bad is yet to be determined. In | | | | organization comprised of medical providers. |
| the meantime, you have choices. Your first choice | | | | Providers contract with the PPO to provide |
| is Preferred Provider Organization vs Health | | | | services at a reduced fee. The schedule of fees |
| Maintenance Organization (PPO vs HMO)? | | | | is negotiated between the organization and the |
| Whether you are offered medical insurance | | | | providers. PPOs are paid by the insurance |
| through your employer or obtain coverage on | | | | company for the use of their network. |
| your own, it is important to know the difference | | | | PPOs generally offer coverage through in-network |
| between PPO and HMO health insurance plans to | | | | providers. You do, however, have the option to |
| make the best choice for you. | | | | see an out-of-network physician but at a higher |
| Deciding which is the better alternative will help | | | | out of pocket cost. |
| you to make a fair comparison of not only health | | | | PPO vs HMO - Major Differences |
| insurance rates but plan features too. | | | | Following are the main differences between an |
| So what is HMO insurance and what is a PPO? | | | | HMO and a PPO: |
| Health Maintenance Organization (HMO) | | | | * Premium - annual premiums for an HMO are |
| Health Maintenance Organization (HMO) is a type | | | | usually lower than PPO plans. |
| of managed care organization (MCO). The HMO | | | | * Flexibility - HMOs usually require visits to your |
| has a network of providers including doctors, | | | | primary physician before seeking care from any |
| medical groups, labs and hospitals that contract | | | | other physician/health care provider. PPOs offer |
| with the organization to provide care for the | | | | greater flexibility with a larger provider network |
| insured members. By contracting with the | | | | and the option to see out-of-network providers. |
| organization, doctors and hospitals agree to follow | | | | Referrals and pre-approvals are not required with |
| specific HMO guidelines. The guidelines include a | | | | PPOs making them more convenient too. |
| schedule of fees for services. | | | | * Cost structure & claim processing - the |
| A primary distinguishing feature of an HMO is that | | | | HMO cost structure is considered to be simpler |
| members must select a Primary Care Physician | | | | than that of a PPO. PPOs often entail deductibles, |
| (PCP) who basically manages the insured's health | | | | co-pays and co-insurance. You may receive bills |
| care. The PCP is usually a general practitioner, | | | | directly from the provider and claim processing is |
| family doctor or internist. With most HMOs, prior | | | | a bit more complicated. With an HMO, the insured |
| to seeing a specialist, the insured must receive a | | | | is usually responsible for office visit copays |
| referral from their PCP. Unapproved visits will not | | | | without the necessity of submitting any claims. |