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Health Insurance

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What is the Difference Between a PPO and a HMO

Preferred Provider Organizations (PPO)

With a PPO, you will have access to a list of “in network” providers that include doctors, hospitals and specialists.  A visit to one of the in network providers will usually result in small co-payment being made by the patient, with the majority of the rest of the bill being paid by the insurance company.  If you choose to visit a healthcare provider that is out of network, you will normally have to front the entire cost of the procedure and seek reimbursement for a portion of those expenses from the insurance company.  With a PPO, if you want to seek the advice of a specialist, you normally don’t need a referral from a primary care physician.

Health Maintenance Organizations (HMO)

With an HMO, you will first need to select a Primary Care Physician (PCP).  Whenever you require medical attention, you will first need to visit the PCP, and they will determine what the best course of treatment is.  If you need to see a specialist, you will need to first get a referral from the PCP.  About the only time you don’t have to see the PCP first is for emergency care.  By law, an HMO must pay for emergency room treatment without a referral.  While a little more restrictive when it comes to physician choices than a PPO, HMO’s are usually one of the least expensive health insurance options for both employers and employees.

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Important: although the information presented on this page was provided by the experienced insurance specialists at, it's use is strictly limited to educational and informational purposes. This information is not to be used in place of the consultation provided by a licensed insurance representative or legal advice of an attorney.