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PPO plans are generally more expensive than HMO plans. As a result, you pay a premium to have greater provider choice as the consumer, but it is worth noting that a PPO network has bargaining power due to its large pool of members.  For instance, this means that by going through your PPO network, you are protected against the exorbitant fees that can accrue for someone accessing care with no coverage at all.  Both an HMO and a PPO are still going to be your cheapest option rather than going uninsured. It can be hard to understand health insurance policies and the difference between PPO and HMO plans. This is why we have made the health insurance comparison tool.
An HMO requires you to select a family doctor, often called a primary care physician or PCP. To see a specialist, you need to go through your selected PCP who will refer you to someone within your HMO network. In addition, an HMO plan will also provide coverage for emergency services if you’re outside the network.

  • It is easy to check online to explore which providers are included in your HMO network. Also, you can verify coverage by calling a provider’s office to submit your policy ID and date of birth. This will give their administrative team the information they need to determine whether you can bill it through your HMO plan.

A PPO is a type of healthcare coverage plan that allows members to see providers both in and out of that plan’s network. In addition, you will have lower out-of-pocket costs by going to an in-network provider. However, you can still obtain partial coverage with out-of-network providers which allows for greater consumer choice and accessibility.

  • Similarly to exploring where you can use an HMO plan, you should look online or call around to see which provider offices are participating as in-network with your PPO.  This will help you compare your in-network versus out-of-network benefits for a particular service.

HMO Plan:
Due to HMO plans only allowing you to see in-network providers, it’s likely that you will never have to file an insurance claim. Furthermore, any provider that you see in your network will be able to bill your HMO coverage plan directly.

PPO Plan:
PPOs have in-network service providers that bill your carrier, but visiting a non-participating provider could require that you pay that provider’s office directly. In order to receive coverage from your carrier after having to pay upfront, you would then need to file a claim for reimbursement.  As a result, these types of out-of-network provider arrangements allow you to get care when you need it without hassle. In conclusion, it is important to make sure you meet criteria in order to access your benefits, especially for higher levels of care.

Here are 8 above all HMO and PPO health carriers today:

  1. Blue Cross scores 9.90/10 for overall rating from Top Ten Reviews
  2. Humana scores 9.70/10 for overall rating from Top Ten Reviews
  3. Kaiser Permanente scores 9.08/10 for overall rating from Top Ten Reviews
  4. Aetna scores 8.75/10 for overall rating from Top Ten Reviews
  5. United Healthcare scores 8.20/10 for overall rating from Top Ten Reviews
  6. Cigna scores 8.13/10 for overall rating from Top Ten Reviews
  7. Molina scores 3.01/10 for overall rating from the Better Business Bureau
  8. Assurant scores 7.48/10 for overall rating from Top Ten Reviews

You can shop affordable marketplace health insurance plans that are tailored to meet your needs during Special Enrollment :

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