Sage-Tips

Is it better to have a PPO or HMO?

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

What is the main difference between HMO and PPO plans that changes the cost to you?

An HMO is a Health Maintenance Organization, while PPO stands for Preferred Provider Organization. The differences, besides acronyms, are distinct. But the major differences between the two plans is the cost, size of the plan network, your ability to see specialists, and coverage for out-of-network services.

What does HMO cover?

An HMO gives you access to certain doctors and hospitals within its network. If you opt to see a doctor outside of an HMO network, there is no coverage, meaning you will have to pay the entire cost of medical services. Premiums are generally lower for HMO plans, and there is usually no deductible or a low one.

Why is HMO so expensive?

“cost more in monthly premium” HMO’s have become very expensive over the past decade as California medical costs escalated. Since the benefits are richer and total medical expenditure has skyrocketed, richer plans are absorbing more of this increase and that gets passed down to you in the form of premiums.

Are HMOs plans cheaper than PPOs?

Costs. The additional coverage and flexibility you get from a PPO means that PPO plans will generally cost more than HMO plans. When we think about health plan costs, we usually think about monthly premiums – HMO premiums will typically be lower than PPO premiums. Another cost to consider is a deductible.

What is wrong with HMO?

In an HMO there are some disadvantages. The premium that is paid is just enough to cover the costs of doctors in the network. The members are “stuck” to a primary care physician and if managed care plans change, then the member may not be able to continue with the same PCP.

Does HMO cover urgent care?

An urgent care center can treat issues like high fever or unusual pain or injury. Your plan will cover urgent care as long as you go to an approved center.