DO DOCTORS PREFER HMO OR PPO?

Are you looking for any health insurance? If yes, you might be looking for health coverage that meets your family’s health requirements and allows you to consult with doctors and specialists of your preference and in your budget too. This is why the most common choice individuals have is between a preferred provider organization (PPO) plan and a health maintenance organization (HMO) plan.

In this article, we will look out for the similarities and differences between HMO and PPO plans to help you pick the right plan.

About HMO plans:

An HMO is a network of health care professionals and hospitals who agree to provide medical care at minimal costs. For reducing the costs, HMO may need you to choose a primary care physician who can provide you medical facilities, refer to good specialists that charge a significant amount. However, an HMO plan will pay for the services provided under the HMO network and for the emergency services availed by the patient from a doctor that is out of network.

These plans are far affordable and lab tests like blood and urine tests are limited to only one lab covered by the HMO plan. Therefore, many individuals prefer to be covered by these plans as they have to pay low monthly payments and can avail the services from their preferred healthcare professional.

Also, in this plan, individuals can choose only one primary care doctor and the patients are covered by individuals who take all their medical services from them. It means that a patient needs to take reference from their doctor before consulting any other doctor except for emergency care.

Consultation or other services to other healthcare professionals outside the network are not usually covered by this plan. The interesting part is, women do not require any type of referral to consult with any other obstetrician/gynecologist covered by the HMO network.

About PPO Plans:

PPO is a group of health care professionals and hospitals who agreed to provide medical care services at fixed costs. However, the best part of PPO is that patients can consult with doctors who are out of network. Though, they need to pay a high amount of copays or out-of-pocket charges for visiting doctors that are out of network.

PPO plans are slightly costly than HMO plans and patients need to pay high monthly payments. With PPO plans, patients need to consult with only one primary care physician but they can consult with the convenient doctor of their choice. Adding on, PPO plans offer more feasibility to go for different lab tests according to your convenient location.

To summarise, the PPO plan offers too much flexibility and the patient does not need any referral inside or outside the network. One of the biggest benefits of the PPO plan is patients do not need any referral to see any other out of network specialist. However, if that doctor is already covered under your PPO plan then all patients can head directly to the specialist of their choice.

Finally, which one is best for you completely depends on your choice of seeing a single doctor or many specialists. With HMO you can only coordinate with a single doctor while the PPO plan provides you great flexibility of looking out for multiple specialists. So, Decide wisely!

Reference:

• https://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/difference-hmo-ppo.html
• https://theolsongroup.com/hmo-vs-ppo/
• https://www.ramseysolutions.com/insurance/hmo-vs-ppo
• https://individual.carefirst.com/individuals-families/health-insurance-basics/understanding-your-coverage/hmo-vs-ppo.page?
• https://thrive.kaiserpermanente.org/thrive-together/health-care-101/hmo-vs-ppo-advantages