HMO or PPO: Which is Better?
In terms of popularity, the Kaiser Family Foundation's 2018 Employer Health Benefits Survey shows that in employer health insurance, PPOs dominate. 49% of covered workers had PPO plans in the survey, while HMOs covered 16%.
When it comes to your own health plan choice, it may sound like a cliche, but when choosing between an HMO or PPO plan, it is not necessarily about which is better, but which is best for you. If you have a choice between these two types of plans, you'll need to consider the pros and cons of each type, and how they apply to your particular situation.
HMOs Generally Win on Cost
If your financial situation dictates that cost is most important, you might seriously consider going with an HMO plan. Generally speaking, costs for HMO plans will be less. Premiums tend to be lower, and deductibles will also be lower, or may be absent entirely. The trade-off will be flexibility, however.
PPOs Usually Win on Choice and Flexibility
If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist. A PPO network will likely be larger, giving you a greater selection of in-network doctors, specialists, and facilities to choose from. Additionally, PPOs will generally have some coverage for out-of-network providers, should you want or need to see one. With HMOs, out-of-network coverage will usually be limited to emergencies; non-emergency services are not usually covered at all.