HMO vs. PPO: What’s the Difference? | Medical Mutual

Hi, I'm Amanda McFarland, and I'm the manager for individual sales at Medical Mutual. The key difference between an HMO and PPO plan is really the provider network. So under an HMO network, it's going to be a closed network, meaning you have to stay with those physicians in order to receive coverage. The only exception to that would be emergency and urgent care. Now a PPO plan gives you a little more flexibility, so you're still going to have a network of providers that you should use, but if you go outside of that network, you'll still have benefits. You're just going to pay more to go to the non-contracted providers. Generally with an HMO, you're going to see lower co-pays on HMO plans, again because you're limited to that network and you have to stay within those contracted providers. So you're probably going to see lower co-pays, lower out-of-pocket maxes, things like that. PPO, if you stay in that network, you're going to have some lower co-pays, but again it gives you that flexibility to go wherever you want and have higher co-pays for non-contracted providers. Probably the biggest thing to consider is who your providers are. If your providers are in the HMO network, then that's typically where members gravitate is towards that HMO, because the benefits are typically going to give you lower co-pays, lower max out-of-pockets, lower prescription co-pays, things like that. Whereas the PPO, if your providers maybe aren't in that network or you just want the flexibility to go wherever you want, that is when you would likely pivot to the PPO plans.