No

HMO plans offer coverage for in-network providers only, with the exception of urgent and emergency care while out of the area.

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Yes

PPO plans offer coverage for both in-network and out-of-network providers, so you’re covered both at home and while away.

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Yes

HMO plans require you to designate a PCP.

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No

PPO plans do not require you to designate a PCP.

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Lower

HMO premiums and out-of-pocket costs are typically lower. Out-of-network services are not covered with the exception of urgent and emergency care while out of the area.

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Higher

PPO premiums and out-of-pocket costs are typically higher. Gives you a greater selection of doctors, specialists, and facilities to choose from.

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HMO plans must use a qualifying enrollment period, such as the annual or open enrollment period, or have access to a special enrollment period due to events such as turning 65, loss of employer coverage, or recent move.

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PPO plans offer year-round enrollment, thanks to the 5-Star Special Enrollment Period (SEP). CDPHP PPO plans are rated 5 out of 5 stars by CMS (Centers for Medicare and Medicaid Services).

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