Ppo Vs. Hmo

In America the cost of health care is on the rise with no sign of becoming any cheaper in the near future. One way of combating this is with the use of health insurance. There are many types of health insurance available but one of the most popular types is managed care. This article will examine two managed care plans PPO and HMOs and will compare and contrast to see the differences and similarities between the two.

HMO' and PPO's are similar in the fact that the two of them members need to choose a primary care physician (PCP). The PCP is responsible for the majority of the medical care for the members of the medical plan. If any member needs to see a specialist, then the PCP has to be consulted and offer a reference before the specialist can be seen. It is with the PCP aspect that the HMO and PCP differ. As stated it is necessary for member of the HMO to have a PCP, this is not true for members of the PPO. The members of the PPO can choose a PCP if they please but they are not required to. This also means that the members of the PPO can refer themselves to a specialist of their choice.




When members sign up for the different managed health care plans, HMO & PPO there are usually different stipulations associated with both. One such stipulation is in regards to medical coverage. Both HMO and PPO members are covered once they seek or receive medical care within the private network. The plan will cover all expenses associated with their treatment. The two managed care plans differ when it comes time to receive treatment outside of the network. HMO members will not receive coverage or benefits if they decide to get medical care outside of the private network. If they do insist on doing so they will have to pay out of their own pocket. Members of the PPO can go outside of the network to receive care; however the coverage benefits would be substantially less. To entice members to stay and receive coverage in network, the PPO often times gives financial benefits which will encourage their members to stay within the network.


In closing the choice of the best managed care plan for you rests on the individual. Both the HMO and PPO have their advantages and disadvantages. Depending on what is the best choice that fits the individual's lifestyle, then they should proceed with managed care plan. HMO is a much more restrictive and you do not have the flexibility in your choices. You do what is laid out to you and if you go outside of their network you will not receive any benefits. The PPO allows you some amount of flexibility but the financial rewards are diminished. You are not tied to a network like the PPO and this increase the options that you have. As stated the difference between an HMO and PPO is all a personal choice and it will depend on what the person wants out of the plan.

By: James Dalton

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For more information on topics related to Pittsburgh Insurance, especially PPO or HMO plans then visit Pittsburgh Health Insurance. James Dalton also writes on Indianapolis Insurance at his website.