Question
HMO vs PPO: what's the difference?
Short answer
An HMO covers care only from its own network and often needs a referral to see a specialist. A PPO lets you go outside the network for a higher share of the cost, and usually costs more each month.
Side by side
- HMO: you pick a primary care doctor, who refers you to specialists. Care outside the network isn't covered except in emergencies. Premiums are usually lower.
- PPO: no referrals needed. Out-of-network care is covered, but you pay more of it, and the out-of-network provider can bill you the difference. Premiums are usually higher.
- EPO: in between. No referrals, but like an HMO, nothing outside the network except emergencies.
How to choose
Look up your doctors first. If they're all in the HMO's network and you don't mind referrals, the HMO is usually the cheaper choice. If you want to keep a doctor outside the network, travel a lot within the US, or have family in another state, a PPO can be worth the higher premium.
Emergencies are protected either way. Plans must cover emergency care outside the network at in-network cost sharing, and federal law protects you from most surprise bills from out-of-network providers in emergencies and at in-network hospitals.
This is general information about how US policies usually work. Your own policy's wording and your state's rules decide the details.