What is the difference between an HMO & a PPO?

HMOs and PPOs are two types of health insurance plans available in California. An HMO (Health Maintenance Organization) requires members to receive care from in-network physicians, while a PPO (Preferred Provider Organization) allows members to receive care from both in-network and out-of-network providers. HMOs are generally less expensive than PPOs, but they have more restrictions on the care one can receive. For example, most HMOs require members to select a primary care physician (PCP) who must refer patients to specialists if they require additional care or treatment. This often leads to longer wait times when seeking specialist care and may limit a patient’s access to certain types of treatment. In comparison, PPOs offer more flexibility and freedom when selecting both a primary care physician and a specialist for treatment. PPOs also offer discounted rates for in-network providers and will typically cover a portion of the cost for out-of-network care, although this amount is often much lower than what is offered to in-network providers. Therefore, depending on one’s healthcare needs, financial situation, and preference for care, either an HMO or a PPO can be a good option when researching health insurance plans in California. Ultimately, it is important to evaluate each option and choose the plan that best meets your individual needs.

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What is the difference between an HMO & a PPO?

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