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Difference Between an HMO and a PPO

HMO vs. PPO: Which One Should You Pick?

Sometimes all these acronyms can make your head spin. All you want to do is pick an insurance plan that will cover your needs — so which one is right for you? Read on to find out:

You should pick a PPO if:

  • You like the flexibility of choosing out-of-network doctors even though you might have to pay more for them.
  • You don't want to jump hoops and request a referral from a primary care physician if you see a specialist. A PPO lets you see a specialist without a referral.
  • You don't mind paying the doctor directly and going through the hassle of filing a claim with the insurance company.
  • You're willing to pay a deductible and higher copays in exchange for flexibility.

You should pick an HMO if:

  • You don't want to bother with filing claims and would rather leave it up to the doctors and physicians to file the claims to get paid.
  • You don't want to pay a deductible.
  • You're OK with sticking to the in-network doctors.
  • You want lower monthly fees and copayments.
  • Note that there may be some limitations on services it covers. You can always appeal it, but it's not certain if you will succeed.

In a nutshell, if you're in good health and aren't picky about doctors, an HMO would be the right plan for you. But if you have favorite doctors that are out-of-network or if you have special needs, get a PPO with a low deductible.

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