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HMO Or PPO - Which One Is Right For Me?

Aug 17, 2007
Rising healthcare costs force us to need to use an HMO or a PPO. Which is the right choice for you, though? These plans are somewhat different and it all can be relatively difficult to understand. Here is a breakdown of the differences between the two so that you can make the right decision overall.

What You Need To Know About HMO's

The HMO is rated slightly higher by Consumer Reports over the PPO. But, the difference in scores is relatively low. These plans are a good choice for those individuals and families that need to keep their out of pocket expenses low as well as those who are okay with allowing the insurance company to choose their doctors. Believe it or not, going with this type of coverage can also help you to keep your bills coming in more smoothly as well.

The average cost per family is about the same or lower than that of a PPO. But, the deductible is significantly lower. It also has a low rated co payment that is due at the time of service, in most cases.

The problems that can occur with the HMO though are several. For one, you may have more trouble getting the help and care that you need and you may have to wait longer to get it as well. Often, when you need to seek the assistance of a specialist or another doctor, you will need to seek approval for the care first.

The PPO: What It Has For You

On the flip side is the PPO. Those who have chronic pain often do better on this plan. If you would like the ability to choose any doctor that fits your tastes and preferences, the PPO is the way to go. You choose the doctor in this plan. The deductible in this coverage often varies depending on who the doctor is and what role he or she plays in the plan. For example, you will pay more for a non-preferred provider as opposed to going with the preferred provider.

The bad side to the PPO is that there are often a number of problems with billing. In fact, it is rated that the PPO will face upwards of three times as many problems getting the right bills to you than with the HMO. You will also have more problems getting hold of the plan as well.

So there you have it, an overview of the pros and cons of HMO & PPO. If this is the starting point of your research, we recommend that you talk directly with people enrolled in the plans that you are considering.
About the Author
Mike Singh is the successful webmaster and publisher of health insurance websites. He provides more information about short term health coverage and health insurance claims processing on this site.
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