HMO vs PPO with Independence Blue Cross

HMO vs PPO with Independence Blue Cross

While Health Maintenance Organizations (HMO) and Preferred Provider Organization (PPO) may not apply to all health insurance plans provided by employers, it is important to understand different plan features.

Health Maintenance Organization (HMO) and Proactive Plans

When using an HMO, members must choose their primary care physician (PCP) who will be responsible for managing and issuing patient referrals when visiting a specialist. With an HMO plan, care must be taken using in-network providers. Out-of-network care is typically only available for emergency care.

HMO plans are generally less expensive than PPO plans while offering mid-range monthly premiums. These prices may depend on the plan while having lower out-of-pocket costs.

Preferred Provider Organization (PPO)

When enrolled in a PPO plan, members have the flexibility to seek healthcare providers both in-and out-of-network. Members are not required to appoint a PCP, but choosing doctors and hospitals in-network may save more money than an out-of-network doctor or facility. Because of this ability to receive more out-of-network care, PPO plans may be more costly with a higher monthly premium.

Questions to Consider When Choosing a Plan

When deciding between an HMO plan and a PPO, it may be good to question:

  • Comfortability first receiving referrals from a PCP to see a specialist;
  • Comfortability with a select network of providers within the HMO plan.
  • Whether plan cost or flexibility matters more to you

If you have questions about your employer sponsored plans, contact your dedicated Creative Benefits, Inc. ESR team.