HMO or Health Maintenance Organization (HMO) plans tend to be more affordable, providing you access to certain doctors and hospitals within its network. The network includes providers that have lowered rates for plan members while meeting quality standards. Unlike PPO plans, care is only provided within the HMO’s network. There are few options to see an out-of-network provider, but there are also typically more restrictions in regard to coverage when compared to other plans. For example, a fixed number of visits, tests or treatments.

• Certain plans require the selection of a Primary Care Physician (PCP) who ultimately determines your treatment.
• Other plans might require a PCP referral to see a specialist or to have specific tests done.
• Opting to see a doctor or specialist outside of the HMO network leaves you to pay the entire cost of medical services provided.
• Provides preventive health care services with no deductible.
• Premiums are generally lower for HMO plans which usually consist of lower deductibles.

Preferred Provider Organization, better known as PPO plans allow you to use any network, in-network or out-network providers. The latter option will incur an increased out-of-pocket cost with a percentage of the medical services offered being covered under your plan. One advantage the PPO plans have over the HMO is that there is no Primary Care Physician provider that needs to be pre-selected. However, you may be required to meet a deductible before coverage kicks in.

• Managed care plan where services are covered only if you go to the doctors, specialists or hospitals in your plan’s network, excluding emergencies.
• Referrals are not needed to see a specialist.
• Typically has a lower negotiated rate compared to HMO Plans.

Exclusive Provider Organization (EPO) plans only offer in-network benefits. This means that only selected hospitals and providers are eligible for coverage under this plan. If you receive health care services outside of your assigned network, you would be responsible for the full amount of the incurred costs.

• Certain plans require the selection of a Primary Care Physician (PCP) who will ultimately determine your treatment.
• Other plans might require a PCP referral to see a specialist or to have specific tests done.
• Opting to see a doctor or specialist outside of the HMO network will not provide coverage which will leave you to pay the entire cost of medical services rendered.
• Provides preventive health care services with no deductible.
• Premiums are generally lower for HMO plans, which usually consist of lower deductibles.