What is the difference between an HMO and a PPO plan?

HMO and PPO plans are both types of health insurance, and they cater to different preferences in terms of flexibility, cost, and networks. HMO stands for Health Maintenance Organization, while PPO refers to Preferred Provider Organization. The primary difference between the two lies in how they manage care and what options are available to policyholders. HMO plans generally require members to choose a primary care physician, who acts as a gatekeeper for all healthcare services. In order to see a specialist or receive specialized care, members must receive a referral from their primary care physician. HMO plans typically have lower premiums and out-of-pocket costs, but they also have limited provider networks. This means that members are required to use doctors and hospitals that are contracted with the HMO, except in emergencies. On the other hand, PPO plans offer greater flexibility when it comes to choosing healthcare providers. Members can see any doctor within the PPO network without a referral, and they can also choose to go outside of the network, although this usually results in higher costs. This increased freedom of choice can come with higher premiums and out-of-pocket expenses compared to HMO plans. Both HMO and PPO plans have their advantages and disadvantages, depending on individual healthcare needs and preferences. Individuals who prefer lower costs and do not mind coordination through a primary care physician might favor HMO plans, while those who value flexibility in choosing healthcare providers may lean towards PPO plans. When comparing options, it could be helpful to review the specific plans available on the GoHealth website to find the one that best suits your needs.