Why would someone choose a PPO over an HMO?


Editorial team Published on

A person would choose a Preferred Provider Organization (PPO) over a Health Maintenance Organization (HMO) to get greater freedom in choosing doctors and coverage for out-of-network care, even though it costs more.

Key Reasons to Choose a PPO

  • No Referrals Needed: You can see medical specialists directly without getting permission or a referral from a primary care doctor.
  • Out-of-Network Coverage: You can visit doctors, hospitals, and specialists outside your plan's network and still receive partial insurance coverage (HMOs generally offer zero non-emergency out-of-network coverage).
  • Keep Existing Doctors: If you already have a trusted doctor or medical team who does not accept your HMO plan, a PPO allows you to keep seeing them.
  • No Primary Care Physician (PCP) Required: You do not have to select a specific primary care doctor to manage and coordinate your healthcare.
  • Travel Flexibility: It is easier to get routine or non-emergency care covered while traveling or living in a different city or state for part of the year.

The Trade-Off

  • Higher Cost: PPO plans come with higher monthly and higher deductibles compared to the budget-friendly nature of an HMO. You also pay more out-of-pocket when visiting out-of-network providers. You can compare general plan differences further through resources like WebMD Health Insurance.