What is the difference between an HMO & a PPO?

The difference between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) in Washington generally depends on the type of health insurance plan chosen. An HMO plan typically includes a broad range of health services at a lower cost than other plans. This plan generally requires members to select a primary care physician and use the providers within the HMO network for most of their health care needs. These visits are usually covered at a lower rate and may not require a copayment from the member. On the other hand, a PPO (Preferred Provider Organization) plan typically offers more flexibility when it comes to selecting a health care provider. While the member must still choose a primary care provider, they are free to use any provider in the plan’s network. They may also receive coverage for out-of-network care, though at a higher rate. PPO plans may also require members to pay out of pocket for some services, such as certain types of specialist visits. In Washington, both HMO and PPO plans are regulated by the Washington State Office of the Insurance Commissioner. Depending on the type of plan selected, the coverage and the cost may vary significantly. It is important to carefully review the plan documents before enrolling in order to understand the differences between HMO and PPO plans.

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