PPO vs. HMO

So it’s time to pick medical coverage—what is the best way to go? What if you need help for something a little more specific, like drug and alcohol treatment?

Substance abuse treatment can be quite expensive. When it comes to your life…well, you only have one. You want the best treatment available for you and your family. You want to pick the best coverage possible for mental health care, but it often isn’t very clear which plan is the best for you.

Benefits and Disadvantages of PPO and HMO Health Plans

Typically when people are trying to decide between HMO or PPO health plans they focus on the network.  Your network includes all of the doctors and hospitals that you can see on your health plan. HMOs tend to have smaller networks, or fewer doctors you can see. Also your primary care doctor has to refer you to any additional care such as specialists, hospitals, treatment centers and rehabs.

With a PPO, you have the freedom to choose any additional care on your own. Plus, there are usually more doctors and hospitals in your network to choose from.

However with that freedom, there are drawbacks. Various state laws prevent HMOs from charging high deductibles (what you must pay out of your pocket) and they cap the amount of money you will pay out of pocket in a year. With a PPO you could face thousands of dollars in up-front costs and end up spending much more on treatment.

PPOs are much more popular right now than HMOs. But why? Most people truly do like the freedom to choose their doctors. But your employer might prefer for you to have a PPO as well, because with a PPO your employer can shift more of the cost on to you as well.

Let’s recap.

• PPOs usually offer more doctors, hospitals and treatment centers to choose from than HMOs
• PPOs allow you to choose additional care and pick the treatment center, rehab or hospital you prefer.
• HMOs require a referral from your primary care doctor before you to go treatment, rehab or a specialist.
• HMOs generally cost less than PPOs—lower deductibles and copays
• PPOs are known to change policy and agreements with their network of doctors, so you always need to check first before you select a treatment center or hospital.

Help Finding Drug or Alcohol Treatment with your PPO or HMO

If you or a loved one is struggling with drug or alcohol problems, you need help now. No matter what your coverage is, we can help you find the best treatment available. Our trained counselors are available 24 hours a day at a toll-free helpline and can help you with everything from finding (any paying for) detox, interventions, therapy, treatment centers and family assistance. All of our calls are completely confidential. Call now to have a caring, live counselor help you learn more about your options.