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What’s the difference between PPO vs. HMO plans?
Posted: June 19, 2020
Last updated date: December 01, 2022
Time and again, members tell us how much they value their relationship with their doctors. And it’s not surprising. It may have taken a lot of time and effort to find doctors who you like and trust. If you’re looking into a dual health plan, you may have seen the terms “HMO” and “PPO” used to describe different health insurance plans. What is the difference between an HMO and a PPO plan, you ask? And which is better, HMO or PPO? It all comes down to choice of doctors. Read on to learn why.
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Everything you need to know about Dual Special Needs Plans in one, convenient guide.
A quick recap on dual health plans
Dual health plans are for people who have both Medicaid and Medicare. These plans usually include many extra benefits and features to help cover more of your care and costs. And you could get them all with as low as a $0 plan premium.
What does HMO mean?
HMO stands for Health Maintenance Organization. Members of HMO plans must go to network providers to get medical care and services. That doesn’t mean they can’t ever see a doctor who’s outside the HMO network. But, unless it’s an emergency, the member may have to pay the whole cost for their medical care.
What does PPO mean?
PPO stands for Preferred Provider Organization. With a PPO plan, members still have access to a local network of doctors and hospitals. But they also have the flexibility to see any other provider anywhere in America. That’s as long as the doctor participates in Medicare and accepts the member’s health plan. If PPO plan members do choose to go out of the PPO network, their plan premium, copay or coinsurance may be higher.
Your choice of plans may depend on where you live
Not all health plans are available in every county across the country. Whether you have the option to choose an HMO or a PPO health plan may depend on where you live. What’s most important of all, is that you have access to a primary care doctor and other physicians you like and trust.
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Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.