When people say “PPO” or “HMO,” they are usually talking about how a plan manages network access and referrals. The labels are not guarantees—always read the plan's summary of benefits for your ZIP code.
HMO-style plans (broadly)
Many HMO designs emphasize a primary care doctor who coordinates care. Referrals may be required for specialists, and benefits are often structured around in-network providers. Out-of-network coverage may be limited except in emergencies, depending on the policy.
PPO-style plans (broadly)
Many PPO designs offer more flexibility to see specialists without a referral and may include some out-of-network benefits (often at a higher cost share). That flexibility can show up in premiums and deductibles, so compare total cost—not just the network label.
What to compare on every plan
- Your doctors and hospitals: are they in network?
- Prescriptions: formulary tier and prior authorization rules
- Deductible, out-of-pocket max, copays, and coinsurance
- Whether you want predictable copays vs more choice
Savino Insurance Group is not a medical provider and does not guarantee coverage. This article is general education only. For advice on a specific policy, speak with a licensed advisor and review official plan documents.