Difference Between HMO and PPO

HMO vs PPO

HMO and PPO are two famous managed health programs in the United States for employees. The difference between HMO or Health Maintenance Organizations and PPO or Preferred Provider Organization is that, unlike HMO, under PPO the employees have the liberty to consult a doctor of their choice without the fear of footing the whole bill.

It is a norm in the United States especially with corporations that employers have to provide employees with health care. This mayright come in the form of compensation or a managed health program such as health insurance. The managed health program incorporates a medical team such as doctors, hospitals and clinics with lab, pharmacy and x-ray facilities. In a few instances, the employer may require the employees to go to a stated health facility, in other cases; the employer simply provides the employee with a health insurance and reimburses the employee for all or a percentage of the medical bills. Two very famous managed health programs present in the United States are HMO and PPO.

HMO

HMO stands for Health Maintenance Organization which requires the employer to provide the employees with a medical network that will comprise of doctors, hospitals and clinics equipped with all the necessary facilities. The employees will have an assigned Physician who will provide the services of a personal doctor and all basic medical services. In the event that an employee requires a specialist, then the Physician will have to refer the patient to a specialist present within the network. In this case, the medical bill is handled by the employer. If however, the employee wishes to consult a specialist outside of the network, then the employee is responsible for the bill.

PPO

PPO stands for Preferred Provider Organization which consists of a network of General Physicians as well as specialists. With this program, the employee can select his preferred doctor. If the employee selects a health care provider from the preferred network, then the employee is only liable for the predetermined annual deductible from their bill. If however, the employee chooses a physician from outside the preferred network then the employee will be liable to pay a higher amount and then put a request under PPO for a reimbursement.

Difference between HMO and PPO

Under HMO, only doctors from the selected network can be chosen, whereas the employee can choose services from within the preferred network in PPO or can also consult someone from outside, and then file for reimbursement with PPO.

Also to consult a specialist under HMO, the employee will require their Physician to refer to a specialist, whereas under PPO, no referrals are required and the employee can select anyone from the network. Employees may even choose to consult out of service physicians under PPO without having to worry to pay the full amount out of their own pocket as they are reimbursed later. With HMO, an out of network service will cost the employee the full amount without any reimbursements.

In Short:

Under both medical plans, the employer is liable for the employees health cover, however, employees prefer PPO because of the liberty to consult a doctor of their choice. Under both services, employers not only cover their employees but also the immediate family, for example spouse and children. In either case, employees receive good health treatment for themselves and their family.