Private PPO vs. HMO Plans
HMOs and PPOs are two ways of organizing a network. HMOs keep costs down by keeping you inside a tight local network and routing care through a primary care doctor. PPOs trade a bit more cost for freedom: see specialists directly and get some coverage outside the network.
The alternative
HMO plans
- Often lower premiums and predictable copays
- Must choose a primary care physician
- Referrals usually required to see specialists
- Little to no out-of-network coverage, except emergencies
- Networks are typically local or regional
With Liberty Health Choice
Private PPO coverage
- See specialists without a referral
- Some coverage outside the network
- Nationwide networks — useful if you travel or have family in other states
- More flexibility to keep the doctors you already see
- Medically underwritten private PPOs can be priced competitively
Side by side: HMO plans vs. private PPO
- Primary care doctor requiredHMO plansYesPrivate PPONo
- Specialist referralsHMO plansUsually requiredPrivate PPONot required
- Out-of-network coverageHMO plansEmergencies onlyPrivate PPOPartial coverage
- Network sizeHMO plansLocal / regionalPrivate PPOBroad, nationwide
- Coverage while travelingHMO plansEmergencies onlyPrivate PPOIn-network nationwide
- PaperworkHMO plansMinimalPrivate PPOOccasional out-of-network claims
Is an HMO always cheaper?
Often, on the marketplace. But an underwritten private PPO can be competitively priced for healthy applicants — so it's worth comparing actual numbers, not just plan types.
Who loves their HMO?
People who live and work in one area, are happy with a single primary care doctor and like predictable copays. If that's you, an HMO can be a great value.
Who should lean PPO?
Frequent travelers, truckers, travel nurses, families split across states, and anyone who wants to choose specialists directly.
Best for: HMO plans
- • People who stay local
- • Anyone happy with a single primary care doctor
Best for: Private PPO
- • Travelers and multi-state families
- • People who want direct specialist access
- • Anyone attached to specific doctors
The verdict
HMOs are a good deal if you live within their walls. If your life crosses county or state lines, the freedom of a PPO usually pays for itself.
More comparisons
See which option fits you best.
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