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HMO and PPO Health Care Coverage
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| A Health Maintenance Organization, or HMO, is a form of health insurance that provides groups with a range of coverage-related services. Members may choose to acquire services from a group of doctors and other medical professionals, without needing to pay a deductible. To ensure coverage, all office visits, prescriptions and other care should be cleared by the HMO. Referrals are typically handled by a primary physician from within the HMO.
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A Preferred Provider Organization, or PPO, is a health care organization comprised of doctors, hospitals and other provides that offers health care services at reduced fees. While they are similar in many ways, a PPO differs from an HMO in that care is paid for as it is received, instead of paying in advance in the form of regularly scheduled payments. Also, PPOs provide greater flexibility by allowing policy holders to visit out-of-network doctors at a slightly increased expense. Care provided from within the network requires only the payment of small fees. Although deductibles and slightly higher co-payments are required for out-of-network services, many people feel more comfortable with the greater number of choices available from a PPO. |
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