What is the difference between an HMO and a PPO?

Hello - I'm curious what is an HMO plan? What is a PPO plan? How do they differ and which one is better? What are the Pro's and Con's of each?

Thanks!

Biggest difference is that alot of doctors/dentists are no longer accepting HMOs strickly on the fact that they do not get paid as well. Make sure the doctors in your town accept the insurance before you sign up for it.

HMO - An insurance plan where you pay reduced fees set by the insurance company at the time of service. A regular office visit fee is charged at every visit. There are no waiting periods, deductibles or maximums. No claim is filed to an insurance company...all payments are made by you at time of service.

PPO - You are charged the usual and customary rate, ie. as if you did not have insurance, and then a claim is filed to the insurance company. Based on your particular plan you will pay the relative percentage that will not be paid by the insurance company. You will have a yearly deductible, maximum and restrictions to what type of work will be covered by your plan based on your current state of health.

Not knowing what the yearly payments are for the HMO or PPO plans you are considering it is tough to say which is better.

I work at a dental office and tell my patients that if they are in need of serious work than an HMO is the way to go. You get the discount on each visit whereas with a PPO once the insurance company has paid your maximum, often $1000, for the year they will not pay another penny no matter what!! $1000.00 may seem like alot but with root canals costing $700 and crowns around $1000 you can see its not much especially if you are in need of multiple crowns or bridge work. Some of our HMO patients pay $100 and $500 for that same root canal and crown.

In the long run it depends on whether you can find a dentist that accepts a HMO, how healthy you are to start and how much your insurance costs per year.

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