HMO Plans vs PPO Plans: What’s the Difference?

Understanding the difference between HMO vs PPO plans will help you pick the healthcare policy that’s right for you.

Understanding the difference between HMO vs PPO plans will help you pick the healthcare policy that’s right for you. Malden Solutions offers comprehensive insurance plans that will benefit both executives and their employees. Whether it’s health, dental, vision, disability, business overhead expense insurance, supplemental benefits, or life insurance, we’ll find plans that will suit you and your needs. Policyholders don’t always understand the difference between HMO and PPO healthcare policies, let alone understand the pros and cons of both. What’s the difference? Keep reading to find out!


PPO stands for Preferred Provider Organization. This feature allows you to go to any healthcare provider of your choice without needing a referral, whether they are inside or outside of the plan network. You also don’t have to designate a Primary Care Physician (PCP). If you go to an in-network doctor, you’ll only be responsible for your copay. If your plan doesn’t include a copay option, then the cost of your office visit will be billed at a negotiated price of the preferred network and then go towards your deductible. If you visit an out-of-network doctor, then you may have to pay out-of-pocket, file a claim, and then be reimbursed later.


HMO stands for Health Maintenance Organization. With this type of policy, you have to designate a PCP who has to plan all of your healthcare services. This physician has access to all of your medical records and gives you routine checkups. To see a specialist, you’ll need a referral from them except in the case of an emergency. If you don’t have a reference, the cost won’t be covered.

How Do I Choose Between the Two?

HMO plans typically cost less and are more convenient, but PPO plans give the option to see any physician that you like at a higher cost. What it all boils down to is your budget and how much control you want to have. Another thing to consider is point-of-service plans or POS healthcare plans which combine both HMO and PPO policies. With a POS policy, you still need a PCP, but you pay for the price of a PPO policy so that you have more coverage for doctors outside of the network.

Partner with Malden Solutions Today

Malden Solutions has a wealth of expertise in providing employer insurance solutions, HR solutions, and individual insurance solutions to businesses both big and small. Our team of seasoned professionals can help you navigate the rapidly-changing world of insurance with ease. We partner with businesses and individuals throughout the country to provide our dedicated services for employee benefits but also work within our surrounding communities in Maryland, Northern Virginia, and Washington, D.C. Contact us today to learn more about how we can provide effective, dynamic solutions for your business.  Stay connected with us on Twitter,Facebook, and Linkedin.

This entry was posted on Friday, June 28th, 2019 at 11:05 am. Both comments and pings are currently closed.