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North Carolina HMO vs PPO Health Insurance Plans : What’s the Difference?

When it comes to choosing a Health Insurance Plan, it is great to have options. However, having options in the Health Insurance market can quickly become overwhelming. Two types of health plans that shoppers often find themselves choosing between are HMO and PPO Plans. One of our most commonly asked questions from Health Plan shoppers is: “What is the difference between a HMO vs PPO plan?” There are many terms that are used to describe these types of health plans, and understanding them is key when determining which plan is right for you.

Health Maintenance Organization (HMOs)

The term HMO stands for Health Maintenance Organization. HMOs are regarded as a managed health care system, which provide prepaid medical services with little out of pocket expense. With an HMO plan, the subscriber will be required to see a Primary Care Physician (PCP) that is in network with their HMO plan. These plans have networks of medical providers, and subscribers must seek treatment from these providers. There are no out of network benefits under an HMO plan. Some HMO plans may also require your Primary Care Physician give you a referral in order to see a specialist. Because these types of plans have more restrictive networks, subscribers will generally have lower premiums and low deductibles under these plans.

Preferred Provider Organizations (PPOs)

The term PPO stands for Preferred Provider Organization. These plans are an arrangement under which a group of independent doctors and hospitals become preferred providers in an area. PPO plans offer more flexibility and choices when it comes to choosing your doctor or hospital. Like HMOs, PPOs also have a network of providers. However, there are fewer restrictions on seeing providers who are not in network. Under a PPO plan, you will also usually have the benefit of seeing a specialist without a referral from your Primary Care Physician. Because PPO plans are more flexible, premiums tend to be higher, and it is common to have a deductible.

Point of Service (POSs)

Point of Service Plans (POS) are a hybrid plan that combine features of PPO and HMO plans. These plans are designed so the member can choose (at the point of service) which part of the plan they would like to utilize. If the subscriber stays in network with this plan, they will have HMO benefits. If the member sees an out of network provider, they will be responsible for the out of network rates. Blue Cross Blue Shield of North Carolina offers a variety of Point of Service health plans. CLICK HERE to generate a custom quote and discover your plan options.

What do these plans have in common?

HMO’s, PPO’s and POS plans all have provider networks. A network refers to the list of doctors, hospitals, labs, and other providers that are contracted with the health plan. The difference in these plans network options is the size of the network, and whether or not the plan offers out of network benefits. Each of these types of plans also offer coverage for emergency services both in and out of network.

At NC Health Plans, we understand that making decisions within the Health Insurance market can be confusing. Blue Cross Blue Shield of North Carolina offers a variety of health plans for both under 65 and Medicare shoppers. Give us a call to speak with one of our professional agents and discover what health plan will work best for you or your family.

For more information on North Carolina Health Insurance coverage, please visit our website at or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.

Tags: Apply for NC Health Insurance, BCBSNC, HMO vs PPO Plans, NC health insurance, POS Health Plans

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