Differences Between PPO and HMO Plans

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When we have a medical emergency, it’s normal for us to wonder what we can do to solve it. There are options we can take into account to obtain the health care we are looking for, the right one for us. For example the PPO Insurance.

Last week we received a patient who told us her story, why and how she chose her insurance, the questions she asked and everything about PPO Insurance and HMO Insurance Plans.

So she researched before making a decision because there are people who still don’t know about the differences among both. Next, we are going to tell you some of them, in case you have the same doubt, we hope to help you.

Because although it may not seem like it, for some people choosing an insurance may represent overthinking, in pros and cons. Positive or negative things before you can make a decision.


HMO Insurance

Health Maintenance Organization (HMO) is a network of medical services that will offer you the care you need giving you a list of doctors or places where you can choose your option.

Keep in mind that this is kind limited at the time of choosing, but it gives you some advantages, which one is to pay less.

An HMO Insurance has the advantage of being a little more affordable, although options are limited.

As you know or as we have said throughout this post, the advantages of your HMO insurance are not as limited as many think when a medical emergency shows, it is likely that your insurance plan covers it.

So do not be afraid, an insurance HMO is not wrong, it has some limitations, but we are sure it will help you.

Picking Doctors

An HMO Insurance doesn’t always give you the choice of the pick; generally, members only can select the health specialist is the name of she or he is on the list they provide you.

We are talking in general, Obstetricians, cardiologists or your Dental office, if they have their names on the list, you can go for it. If is not, you need to stick to the list.

But this depends on the company and group plans of your insurance.

The list of doctors who are affiliated with your health insurance can be broad, which means that you really have options to choose from. You must not believe that they do not give you an option because there are.

The question is that not all the time is what you are looking for.

Others Services

HMO may cover screenings, X-rays, and some other scans or other services.

x ray


Also, your primary care doctor can prescript drugs, but you need to figurate out if your plan covers it.

You will need a referral before going to a specialist that means a person who can provide contact with doctors and specialists and tell you where to go to receive your medical attention.

Keeping your Doctor

If you already have a doctor of your trust and a team of specialists, people who already have your clinic file and all your information, it will be difficult to continue with them if you choose to have coverage with a follow-up HMO.

As we have already stated, having an HMO Insurance implies sticking to the list that they give to you and not always will be listed the places where you really want to go or the doctors you used to have.

Many people see it as a negative point, and they would prefer to maintain contact with their current medical team.

It can be an issue if you think about it because maybe is people you know for life and they see you, they know all you have been through.

So, if you are thinking of changing you need to consider that there’s a big chance that maybe you don’t see your doctor again. Keep in mind one thing, if you have a family you are making changes for them too.

PPO Insurance

Preferred Provider Organization (PPO) on the other hand can provide you benefits as well. Our patient says to us that it was tough to make a decision, but finally, after seeing all the information, she chose.

This plan is the most popular, one of the reasons could be that you don’t need a referral to ask for your medical services.

Also, the options you have for medical services, including Dental Services, can work for you because a PPO plan gives you some names of doctors, specialists, and everything, but also they let you search by yourself.

In other words, this can be some good news; you maybe can be able to keep the touch with your primary doctor or your dentist.

Let’s Talk About the Cost

PPO plans usually may have higher monthly charges, but are more flexible, since they offer the possibility of you choosing your Dental Office or doctor either is inside or outside of their network, without needing to request a referral.

Medical out-of-pocket costs can also be higher with a PPO plan.

This will be a crucial moment for you and maybe your family because some people just listen that the plan is a little more expensive compared to the HMO, and they immediately prefer the cheapest one.

Dental Money

However, what is more, affordable not always means the best decision.

So when you need a dentist, you can keep the one that knows everything about you, the one that knows your family with a PPO plan.

Here we have an excellent point to take into account when you are choosing. Think in that you will be free of selecting the person who is going to be in charge of your health.

So, maybe you need to perhaps some extras, but you’ll have the chance to look by yourself, and you don’t need a referral.

Imagine just for a second having the freedom to choose your doctor or dentist, no matter how much you can pay for deductibles or something similar.

You will have the opportunity to find someone of your complete confidence thinking of what is the best for you and your family.


Some of our patients share some good stories about them taking the decision, every day we have people telling us their experiences about having HMO or PPO insurance.

They have said us details that perhaps we did not imagine or did not know, but of course, they told us which was the best for them.

Some have said to us that it does not matter if you have to pay a little more with one, you will have the freedom to choose between all the alternatives that you have at your disposal.

Others have told us that having affordable prices or not is not an option for everyone.

Only because of economic possibilities, they have to choose the one that best suits their needs.

This is something very relevant to mention because although you are in a dilemma between your alternatives, not in all cases, you can choose the one you like the most for money matters.

There are some worse cases because we have known people who do not even have insurance.

Some people only approach and confess that they have insurance, neither medical nor dental.

So, what is the Best?


You must analyze your alternatives, your budget and consult it with your family if is necessary. This is not something that is taken lightly or that is a straightforward decision to make, it is not, it’s about your safety, your health.

The patient who told us her story said that, although it will represent budget adjustments in her lifestyle, she decided to opt for PPO insurance.

With the HMO she had to go with a leading doctor, who would be referring specialists that she might need for their procedures and other services.

This idea did not seem attractive to her at all, she saw it as something that she would be forced to do, although, in reality, it is not like that.


The PPO Insurance gives you a list of participating clinics or affiliated with their programs, for her this was very good because she would not have to go too far when choosing a dentist, for example, since her plan included what she was looking for.

And in other aspects, if it left the list it was not going to represent big extra expenses for her.

There are several categories of health insurance.

For instance, there’s the “traditional” plan or the “indemnity.”

By joining one of these types of plans sh e would get coverage for medical expenses, surgery and hospitalization, many of these programs will cover prescription drugs, as well as dental and vision coverage and most cases.

Making the Final Decision

At this point, you may be still wondering what is the best one for you and the only thing we can tell you is that It really doesn’t matter what decision you make, as long as you keep in mind that it is something that will bring you benefits and that each case is different.

Things can vary from person to person, by their lifestyle, by their economic income, by their needs or their way of seeing life, including their ideals.

For which we say that it is something that you should consider not in an exaggerated way because it will give you a headache, but to take it into account.

Some patients have told us that they feel relaxed paying for insurance, any, and others have merely said us that they do not see it as necessary and they have their reasons to see it in this way and it has worked for them.

So what you decide should be coupled to what you want and want, to get the benefits you need.


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