Health Maintenance Organization (HMO)
If you join an HMO:
- You must use the doctors and other providers in the HMO network.
- Most HMOs ask you to choose one doctor to be your primary care provider (PCP). Your PCP takes care of most of your medical needs.
- You have to get approval from your PCP before you can see a specialist.
There are advantages:
- You usually pay only a small amount when you get care (for example, $10 for an office visit).
- You have very little paperwork.
- You may also receive better coverage for some services, such as preventive care.
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Preferred Provider Organization (PPO)
If you join a PPO:
- You can choose whether or not to use the PPO's network.
- There are advantages if you do use the PPO's network.
If you see a doctor who is in the PPO's network:
- You will pay less when you get care and you will have less paperwork.
- You may also receive better coverage for some services, such as preventive care.
If you choose to see doctors and other providers who are not in the PPO's network:
- You will pay more when you get care.
- You will have to file claims to get payment.
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