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How Do I Choose Between a PPO or HMO?

Updated: Aug 9, 2021

By: Brian Barto, Independent Insurance Broker: VA and WV






PPO or HMO? Which one is right for you?

There are a lot of decisions to make when it comes to choosing a health insurance plan and it’s always good to have options.


Two popular types of Medicare advantage plans available in the insurance market are :


  • Preferred provider organization (PPO) plans

  • Health Maintenance Organization (HMO) plans


Let’s take a closer look at each to learn more about how they're alike, how they're different, and how you can choose the type of plan that meets your needs.


HMO Plans :

  • Care under an HMO plan is covered only if you see a provider within that HMO’s network

  • Most HMO plans require you to select a primary care physician (PCP).

  • With some plans, you may need a PCP referral to be covered when you visit a specialist.

  • There is NO coverage if you choose to see a doctor outside of an HMO network, meaning you will have to pay the entire cost of medical services.

PPO Plans

  • PPO plans also feature a network of providers, but there are fewer restrictions on seeing non-network providers.

  • PPO insurance plans will pay if you see a non-network provider, although it may be at a higher rate.

  • You can see the doctor or specialist you’d like without having to see a PCP first (no referrals needed).

The main differences between HMO and PPO plans include network size, ability to see specialists, costs, and out-of-network coverage. Compared to PPOs, HMOs cost less. However, PPOs generally offer greater flexibility in seeing specialists, have larger networks than HMOs, and offer some out-of-network coverage.


Which plan is better? Both types of plans are available in our service area. When choosing between an HMO or PPO plan, it is not necessarily about which one is better than the other, but rather which one is best for you. Finding the right coverage between all the available choices in the market is not an easy task and can become very frustrating.


We are here to help: Our team of dedicated Independent Insurance Agents are here to assist you with exploring your unlimited coverage options and find the best plan that meets your medical needs and financial budget. Call us today at 540-662-4432 for a free consultation appointment and visit our website: www.medicaretrustedagents.com to find more information.

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