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Health Maintenance Organization (HMO)

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Spotlight on: HMO Insurance

If you’re shopping for personal health insurance, you’ve likely heard the terms HMO and PPO.

While both plans can help pay for routine health care services, checkups and other medical care, there are a few key areas in which they differ.

Grounded in your priorities and elevated in your opportunities, Higginbotham is here to help you decide which plan makes the most sense for your lifestyle.

The Higginbotham Difference

We lead with accountability so you can lead with confidence.

Our authentic and transparent approach to health insurance takes the headache out of HMOs.

From taking the time to learn about your lifestyle to educating you and your family on the options that make sense for your needs, the health insurance specialists at Higginbotham can be held accountable.

And we don’t stop there. We stand by you 365 days a year to answer your questions and help make sure you get the most out of your health coverage.

Because when you lead with values, value leads.

To learn more about how our values-based approach drives value, click here

Or visit our Insights page to learn more about health insurance.


Connect with an HMO Specialist

Work with a broker who listens. Get coverage that makes sense for you.

If you’re still unsure of which plan makes the most sense for you, our health insurance specialists are standing by to answer your questions.

Request a Quote Let’s Talk

We just completed our fifth renewal with Higginbotham, and each year I have felt that TJ not only represents us, but he cares about us and all the families on our plan. He knows what is important to us, and every year he finds a way to deliver.

Monique D.
Controller, Staffing Industry
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Young Woman Having Online Meeting With Female Healthcare Person
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HMO Plan Essentials

The most considerable difference between health maintenance organizations (HMO) plans and preferred provider organization (PPO) plans lies in the way you access care.

Unlike a PPO, which allows you to visit a physician or see a specialist of your choosing, an HMO requires the appointment of a primary care physician (PCP) as a prerequisite to receiving care services.

Once you choose a primary care physician, that provider essentially becomes a portal of care, giving referrals for specialist appointments as needed.

Outside of the requirement to choose a primary care physician, there are a few more key differences between a PPO and HMO to understand.

To start, the out-of-pocket costs for regular care on HMO plans tend to be considerably lower than their PPO counterparts. And, an HMO plan also tends to have lower monthly premium costs. Another key difference between these plans lies in the way you access care. In addition to requiring a referral to see a specialist, an HMO plan will not pay for a visit to an out-of-network care provider.

If you need to see a doctor or visit a hospital while traveling, or your primary care provider is unavailable, you will need to pay for those services out-of-pocket.

While this can be troublesome for policyholders with chronic health issues or an above-average need for care services, in-network HMO plan requirements can offer added convenience for those who rarely need medical care.

Because HMOs only pay for in-network services, they often do not require you to file a claim to get the insurance carrier to pay for services. As a bonus, many HMOs have direct payment arrangements with in-network care providers, lowering the initial out-of-pocket cost for a doctor visit.

Is an HMO plan the right choice for me?

When deciding between an HMO vs. PPO plan, you should carefully consider several factors.

For some, the risk of a large out-of-pocket medical bill is worth the savings on monthly premium and care costs an HMO can offer.

Consider these factors to help decide:

  • How Frequently You Anticipate Needing to See a Doctor
  • How Often You Travel
  • Specialist Care Needs
  • Health Care Budget
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Not sure where to start? Talk to someone who wants to listen.

A great plan starts with a conversation. Let’s talk about what you need.

Talk to an Employee Benefits Specialist

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