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What is the difference between an HMO
and a PPO health plan? |
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In general, HMO’s
or Health Maintenance Organizations are specific health insurance designs whereby
the insured is under the care of a “gatekeeper” or primary care
physician. This physician is
selected by the insured and is a participating provider within the network of
physicians contacted with your insurance carrier. This primary care physician guides the
member’s care and gives referrals to specialists such as
dermatologists, or therapists.
With HMO policies, the member has no coverage without these referrals
and must remain inside the network of physicians in order to have
coverage. These plans were
popular in the late 90’s as they were offered at low rates while
marinating low co-pay’s for routine doctors office visits and
hospitalizations. A PPO plan or
Preferred Provider Organization is a plan that allows the member to utilize
providers either inside, or outside of the participating provider
listing. The member self refers
to specialty providers and is not required to select a primary care
physician. The plan is deductible
driven much like your automobile insurance and the best benefit is received
when the member remains in-network. |