HMOs Don't Offer the Same Benefits as PPOs - HMO Myth

One of the common myths about HMOs is that they don’t offer the same benefits as PPOs. HMOs have changed over the years. Blue Cross and Blue Shield of Texas reviews this common myth and talks with everyday people who share their thoughts and experiences with HMOs. You’ll learn more about HMOs and whether this myth is true or false. 

Show Transcript
NARRATOR: Is there a difference in what HMOs cover versus PPO?
MAN 1: I was actually impressed with the things that the HMO had, better than the basic plan. A couple of times I was having back issues from previous sports injuries. And they sent me to chiropractors, which I didn't realize at the time that HMO had, as well as PPO. It was just a select group of doctors. With the PPO, I could go anywhere. But with the HMO, they still had a lot of good doctors, so it was just pretty much the same.
WOMAN 1: I haven't had an instance where it didn't cover anything.
NARRATOR: Today, with the Affordable Care Act, HMOs and PPOs cover the same essential health benefits, like preventative care, emergency services, prescription drugs, mental health, and much more. To learn more about HMOs, visit our website.
  • PPOs are far superior to HMOs.  PPO patient is in control of care and decisions, not the PCP. HMO the PCP is in control of the patient's care and decisions.

    PPO - If someone needs to go to a cardiologist they simply find one in network and make the appointment and go missing one day of work.

    HMO - If someone needs to go to a cardiologist they must go to PCP and explain why a cardiologist is needed. PCP may try to treat the condition first before sending them to the Cardiologist wasting time and money before they finally get the care needed in the first place or PCP refuses to give a referral or refuses to referral to the Cardiologist of the patient's choice. In the meanwhile, they get sicker and end up in the ER paying even more money because of the HMO and PCP.