How do HMO and PPO insurance plans differ?

The distinction between Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) primarily revolves around the management and coordination of care. HMOs require members to have a primary care physician (PCP) who acts as a gatekeeper for healthcare services. This means that before seeing a specialist or receiving specialized care, members must first consult their PCP. The requirement for a PCP helps ensure that care is coordinated, which can lead to efficient management of healthcare needs and cost containment for the insurer.

In contrast, PPOs provide greater flexibility in choosing healthcare providers and typically do not require a primary care physician or referrals to specialists. This makes them more attractive for individuals who prefer to have more control over their healthcare decisions and want to see specialists directly without having to go through a PCP.

Therefore, choosing that HMOs require members to use a primary care physician accurately captures a fundamental aspect of how these two types of insurance plans operate.