There are a lot of differences between a PPO and an HMO, but the biggest differences are in how you access care, and what providers you can access.
“PPO” means Preferred Provider Organization. A PPO is a healthcare network system where the providers are contracted with a carrier to provide healthcare at a discount or for a fixed fee.
Members can access care from PPO network contracted providers, or from non-contracted out-ofnetwork providers.
“HMO” means Health Maintenance Organization. An HMO is a prepaid healthcare plan that offers members a variety of comprehensive healthcare services available from a specific group of contracted hospitals and medical professionals.
If you elect PPO coverage, you can see any licensed physician or provider in the PPO-network or out-of-network. Of course, if you see a Blue Cross PPO-network provider, the plan’s reimbursement will be greater than if you see an out-of-network provider.
If you elect HMO coverage, your non-emergency care is managed by a Primary Care Physician (PCP); Specialty care requires a referral from your PCP. You are generally limited to seeing only providers contracted with the HMO. Most Blue Cross HMO services have no or very limited out-of-pocket cost to the member.
