Difference Between PPO and HMO Plans

Insurance Plan Options

Difference Between PPO and HMO Plans

Understanding the difference between these two types of plans is very important before signing up for coverage. Depending on your personal preference and price point, you might be a better fit for one or the other. Even though there are differences between the plans, they both still provide real insurance coverage and protect your savings and assets.

How They Work

When choosing a qualified plan, the plans generally fall under two categories which are PPO and HMO plans. A big difference between PPO and HMO plans is that PPOs have coverage for out of network expenses. They also have an out of network maximum out of pocket. The maximum out of pocket number is generally two times the amount as your in-network out of pocket expense. PPO plans also have larger doctor lists and does not require you to have a referral to see a specialist. If you are on an HMO policy, you will have to go to your primary care physician first. They determine if it is medically necessary to see a specialist. While individuals have only one carrier in Nevada providing PPO plans, health insurance small business plans have many PPO choices. Our office provides group health insurance quotes and quotes for individuals for all plans in Nevada.



Because PPO plans have more freedom and out of network coverage, they are more expensive than HMO policies. The price difference between PPO and HMO policies can range anywhere from 5 – 20% or more. If you are comfortable or have used an HMO policy and do not mind seeing your doctor before going to a specialist, the plans can help save on your monthly cost. It is important to note that even though an HMO does not have out of network coverage, emergency situations are still covered as an in-network benefit. This means that if you were outside the state of Nevada. If you have an emergency, you can go to the nearest hospital and pay the same amount you would normally pay here.

Please give our office a call if you have any additional questions about these types of plans or would like to enroll in a policy. As your health insurance broker, we do not charge you any fees for our services. We also provide you assistance with the plan throughout the year and shop new plans once it comes time to renew.