HMO vs PPO – Health Insurance

In the approach of making Health Insurance choices,  it is crucial to understand the difference between HMO and PPO plans.

  • HMOs usually offer lower premium and lower out-of-pocket expenses, but allow limited access to care outside the network
  • PPOs offer more flexibility in providing access in and out-of-network, but tend to have higher priced premium and out-of-pocket expenses

Reference table for a quick comparison:

Plan feature HMO PPO
Designate a primary   care physician? Yes No
Need a referral to see a specialist? Yes No
Out-of-network   benefit? No Yes
Level of flexibility Minimal High
Access to   convenience care and urgent care clinics Maybe Yes