Which plan is right for me?What is an HMO?A Health Maintenance Organization (HMO), is a type of health plan that offers a local network of doctors and hospitals for you to choose from. It usually has lower monthly premiums than a PPO or an EPO health plan. An HMO may be right for you if you’re comfortable choosing a Primary Care Provider (PCP) to coordinate your health care and are willing to pay a higher deductible to get a lower monthly health insurance premium. Show What is a PPO?A Preferred Provider Organization (PPO), is a type of health plan that offers a larger network so you have more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan. If you're willing to pay a higher monthly premium to get more choice and flexibility in choosing your physician and health care options, you may want to choose a PPO health plan. What is an EPO?An Exclusive Provider Organization (EPO), is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO is usually more pocket-friendly than a PPO plan. However, if you choose to get care outside of your plan’s network, it usually will not be covered (except in an emergency). If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan. HMO, EPO, and PPO Frequently Asked QuestionsWhat’s the difference between in-network coverage and out-of-network coverage?Each time you seek medical care, you can choose your doctor. You have the choice between an in-network and out-of-network doctor. When you visit an in-network doctor, you get in-network coverage and will have lower out-of-pocket costs. That’s because participating health care providers have agreed to charge lower fees, and plans typically cover a larger share of the charges. If you choose to visit a doctor outside of the plan’s network, your out-of-pocket costs will typically be higher or your visit may not be covered. What if I need to be admitted to the hospital?In an emergency1, your care is covered. Requests for non-emergency hospital stays other than maternity stays must be approved in advance or pre-certified. This allows Cigna to determine if the services are covered by your plan. Pre-certification is not required for maternity stays of 48 hours for vaginal deliveries or 96 hours for caesarean sections. Depending on your plan, you may be eligible for additional coverage. Who is responsible for getting pre-certification?Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis. If your doctor is in the Cigna network, they will arrange for pre-certification. If you use an out-of-network doctor, you are responsible for making the arrangements. Your plan materials will identify which procedures require pre-certification. How do I find out if my doctor is in the Cigna plan’s network before I enroll?It’s quick and easy to search for participating doctors, specialists, pharmacies, hospitals, and facilities to match your needs.
Thanks for visiting! GoodRx is not available outside of the United States. If you are trying to access this site from the United States and believe you have received this message in error, please reach out to and let us know. HMOs and PPOs are two common types of health insurance plans. If you’re trying to decide which to choose, it can help to know the basics of both, plus key differences. An HMO, or
health maintenance organization, is a plan that offers members care within a specific network of doctors, hospitals, and other medical providers. These are called in-network providers. Your costs are typically lower with an HMO because it already has agreements in place with providers. They pay less to providers they have contracts with, so you pay less for the
plan. If you use a provider that isn’t in the HMO’s network, known as an out-of-network provider, the plan typically won’t cover your visit unless it’s an emergency. As an HMO member, you pay a monthly premium and a copay when you seek care. You choose a primary care doctor to coordinate your care. If you need to see a specialist, your primary care doctor must give you a referral. With a PPO, or preferred provider
organization, there’s more flexibility where you seek care. You can see doctors who are out-of-network. You can also see a specialist without getting a referral. But if you get care from a provider that’s in the PPO network, you pay less. Your out-of-pocket costs will be lower and your coverage will be more thorough. If you choose care from a provider that’s out-of-network, your out-of-pocket costs will be higher. You’ll pay more for some services, and others may not be covered at
all. Your PPO has agreements with in-network providers to pay a set fee for each service. PPOs usually have a set rate they will pay for an out-of-network service or provider. If you go out-of-network and the doctor or medical facility charges more for a service, you have to pay the difference. The main differences between HMOs and PPOs are affordability and flexibility. Cost.
HMOs are more budget-friendly than PPOs. HMOs usually have lower monthly premiums. Both may require you to meet a deductible before services are covered, but it’s less common with an HMO. With a PPO, your monthly premiums may be higher, but you will have some coverage if you go out-of-network. HMOs typically don’t provide coverage for out-of-network providers unless it’s an emergency. Flexibility. PPOs have more flexibility than
HMOs. You choose which doctors you go to. You can see providers that are in-network or out-of-network. You don’t need prior approval or a referral from a primary care doctor. If you choose a PPO and your doctor isn’t in-network, you don’t have to change doctors to be covered. Think of it as a trade-off. With an HMO, you pay less but have less flexibility where you get care. With a PPO, you pay more but have more options. Comparing the advantages and disadvantages of HMOs and PPOs may help you decide which is best for you. HMO advantages PPO advantages HMO drawbacks
PPO drawbacks
How to ChooseDeciding between an HMO and a PPO depends on your needs. These questions may help you choose.
When you answer these questions, you’ll have a better idea of which may be a bigger priority: flexibility or affordability. If lower out-of-pocket costs are more important than having more choices, an HMO may be right for you. If more flexibility is more important than keeping costs down, a PPO may be a good choice. The plan that’s best for you is the one that meets your needs and priorities. |
What is the difference between a ppo and hmo insurance
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