Medical

HMO

The Health Maintenance Organization (HMO) plans provide health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.

PPO

These plans operate as preferred provider organizations (PPOs). A PPO is similar to a traditional "fee-for-service" plan, but you must use the doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.

For more information, you can review an article released in the CalPERS publication, PERSpective: HMO, PPO, and EPO – What’s the Difference and Why Does It Matter?

HMO: When enrolling in an HMO plan, you must select a Primary Care Physician (PCP) from a list of "in-network" doctors.  The PCP will direct all your care and will provide you with a referral if you need to see a specialist.

PPO: Yes, you can choose any doctor you prefer.  However, you will save money if you choose doctors who are "in-network".  You also have the freedom to see a specialist without a referral.