The difference between PPO's and HMO's is growing blurry, but generally PPO's give you greater freedom in choosing a doctor and generally don't require referrals. With an HMO your care is coordinated through your primary care physician (PCP) (United Healthcare and Anthem Pathways are an exception to this rule). Your HMO PCP will refer you as necessary to specialists or other doctors. PPOs allow you to see specialists without referrals, as long as they are in their doctor network. PPOs typically have some coverage for out-of-network services, although at a higher cost to you than in-network. The increased freedom of choice of a PPO does result in more cost-sharing by the consumer.
Talk to us about HMOs, PPOs and the new EPOs.