HMO vs. HPO: Understanding Health Insurance Plan Differences

The majority of Americans receive health insurance through their employer. Most employers enroll employees in health maintenance organizations or health provider organizations. Although these two organizations are similar in many respects, there are some crucial differences.

Primary Care Physicians

• All HMOs require you to select a primary care physician who oversees all your health care needs. Your PCP must be part of the HMO's network; you cannot choose just any doctor you want as your PCP. HPOs do not require you to select a single PCP. You can visit any doctor cheaply so long as that doctor is in the network. You can also visit a doctor outside of the network, but you will pay a lot more money.

Referrals

• HMOs only allow you to see a specialist if your PCP writes a referral for you. HPOs allow you to meet with any specialist so long as the specialist is part of the HPO's network. It will cost more to visit a specialist outside the HPO network.

Additional Services

• Many HMOs require you to pay a copayment for doctor's visits and extra charges for prescriptions and procedures like surgeries. Most HPOs only require you to pay a copayments on any sort of medical treatment you receive.