HMO vs. PPO: Understanding the Difference and Switching

An HMO, or health maintenance organization, is an insurance plan that requires you to declare a primary physician who you will see for any and all ailments. The primary you choose will decide what sort of specialist you see by referral for treatments outside of his office. With a PPO, or preferred provider organization, you are free to schedule appointments with specialists. Some patients would rather go directly to the needed specialist and feel it is a waste of time to see a primary physician for referral.

Step 1

Contact your insurance agent or see your company human resources representative to discuss your health insurance coverage. Ask about the next available enrollment period and find out if you must wait until then to change health insurance coverage from your HMO to a PPO.

Step 2

Select the particular PPO plan that suits your needs and fits your budget. Some providers only make one plan available, but others offer coverage on various tiers at different prices. Fill out all the paperwork necessary to confirm your chosen policy.

Step 3

Enroll in a new preferred provider coverage plan as soon as you are eligible to change health insurance policies. Pay the increased cost of premiums for the policy. A PPO typically costs more than an HMO regardless of coverage tiers selected.