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Thursday, February 19, 2009


PPO vs. HMO: Who can say which is better, and how do you decide? Surely if you compare the two, you are bound to come up with a favorite, but which will it be? What factors will influence your decision. One thing that will influence you strongly is your financial situation. The other is your definition of good health care. Here are a few facts about these two forms of insurance that should help you solve the riddle of PPO vs. HMO.

Lets start by defining the two. First is PPO. This is the Preferred Provider Organization. The other is HMO. That is the Health Maintenance Organization. Both are popular insurance providers. Of course, HMO is the original and has always been intended to provide medical care at a low cost by using preventative medicine. Interestingly, this also defines PPO. Both of these types of insurance cover such items as immunizations, well baby care, maternity care, physicals, office visits, and more. To this point, PPO vs. HMO are neck and neck!

Both types of coverage work with a network of healthcare providers, physicians and hospitals. They are both paperless systems in which you are not required to file medical claims yourself. You simply hand your card to the receptionist, and your information is automatically documented. With both systems, you will be able to have complete coverage and take advantage of this automatic filing system as long as you stay within your network.

What about a primary care physician? Is there a difference there? No! When considering PPO vs. HMO, they are identical in this respect. In both instances, when you enter the network, you will choose a primary care physician who will then be the key player in determining what types of medical care you will get.

Here is where the two providers begin to take different paths. With an HMO, if you wanted to see a specialist outside of your network for a specific problem, and you did not want to see your primary physician regarding this particular problem, you could not have coverage at all unless your primary physician decides to give you a referral to that specialist. With a PPO and the same scenario, you would have partial coverage if you decide to see a specialist outside of network without the OK of your primary physician.

When comparing PPO vs. HMO, money is another major consideration. Like with everything else, you get what you pay for. An HMO is usually less expensive than a PPO, and it offers less choice in providers. Although a PPO costs more, you will sometimes have the option of using services outside the network. One thing to remember about this is that if you use a service provider outside the network, you will probably have a mountain of paperwork to fill out.

Of course the final decision regarding PPO vs. HMO is up to you. There are pros and cons to both. One thing you will probably really want to consider is the availability and type of doctors near you. Clearly, if there are no PPO doctors nearby, then you will need to choose one plan over the other one. However, you might face the same dilemma regarding money. No matter which one you ultimately choose, be sure to make an informed decision. Comparison shop and do a bit of research. This could save you quite a bit of money.

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