What’s the difference between HMO and PPO insurance plans?

Business Health Trust partners Premera Blue Cross and Kaiser Permanente – two of the most well respected insurance companies in Washington State. Premera’s most popular plan is a PPO while Kaiser Permanente offers both an HMO and PPO.

While HMOs have been around since the early 1900’s, PPO is a descendant with some new features based on challenges with HMOs. This doesn’t mean that PPO is always the best as it depends on your needs and your employees’ needs. The main differences between HMOs and PPOs has to do with the number of options for providers, accessibility to specialized providers, and the cost when it comes to plan monthly premiums.

What does HMO stand for?

HMO stands for Health Maintenance Organization.

What does PPO stand for?

PPO stands for Preferred Provider Organization.

Benefits of HMO vs PPO

Although each plan varies, in general, HMO insurance plans are more economical and come with lower monthly payments, lower deductibles, and lower prescription costs. In some cases, there may not even be a deductible. The tradeoff is not having the flexibility to work with providers outside the main network and the requirement to go through a primary care provider for specialist referrals. The other good news is that patients won’t be hassled with filing claims on their own for out-of-network care.

Benefits of PPO vs HMO

PPO comes with more flexibility as your employees will be able to choose from in-network and out-of-network providers. Better access to specialized care is a plus as well since they generally won’t need a referral from a primary care doctor. Though all plans are a bit different, for the most part, these perks mean higher fees and potential restrictions on which medical services are covered. On the other hand, lower copays and dependable coverage can be expected for in-network trips.

HMO vs PPO: Which is better?

It depends! For employees who will be working with a single provider or looking for lower monthly insurance premiums, an HMO may be appropriate. If they’ll need more flexibility or more specialized care a PPO could be important.

Is Kaiser an HMO or PPO?

Kaiser Permanente actually offers both HMO or PPO, so this should be considered if offering this HMO/PPO option for your employees is important. Those both insurers have large networks of highly respected primary care providers and specialists, Premera, with their PPO offering, comes with the largest network.

Who is Eligible?

Washington companies with two or more enrolled employees are eligible to participate in the Business Health Trust benefit program. Participation requires membership with the Seattle Metropolitan Chamber of Commerce or one of our partner organizations: Bellingham Regional Chamber of Commerce, Economic Alliance Snohomish CountyTacoma-Pierce County Chamber of Commerce, Thurston County Chamber of Commerce, Greater Yakima Chamber of Commerce and Archbright. Your membership in any of the above organizations automatically qualifies you for one of our 13 industry group memberships (at no additional cost), and all the advocacy, resources and savings that go along with it.

Interested in other comparisons?

Take a look at some of our other comparisons: