What is the difference between a PPO and an HMO?

The difference between a PPO and an HMO is an important distinction for those seeking health insurance coverage in Virginia. A Preferred Provider Organization (PPO) is a type of health plan that contracts with medical providers, such as hospitals and doctors, to provide care at discounted rates. With a PPO plan, members typically have access to a larger list of doctors and hospitals than an HMO and they are not required to select a primary care physician. Additionally, PPO plans are usually more expensive than HMO plans and members are responsible for any medical fees that exceed their plan’s coverage limits. On the other hand, a Health Maintenance Organization (HMO) is a type of managed care plan and typically offers lower premiums than a PPO. With an HMO, members must choose a primary care physician and receive referrals to see specialists. Additionally, the team of doctors in an HMO will coordinate care for members, ensuring that they receive the best care possible. However, HMOs usually have a much smaller list of providers for members to choose from. In Virginia, employers can offer either a PPO or an HMO health plan to their employees. It is important to understand the differences between these two plans in order to make an informed decision when selecting a health insurance plan.

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