What to Expect When Switching from PPO to HMO Check out our blogs, articles, news, and updates for all things health insurance

Our Blog Provides Insights and Information on All Health Coverage and Health Insurance Topics
Nov 4, 2023

What to Expect When Switching from PPO to HMO

Switching from a Preferred Provider Organization (PPO) health insurance plan to a Health Maintenance Organization (HMO) plan can be a big decision. It's important to understand the differences between these two types of plans and what to expect when making the switch.

Understanding PPO and HMO Plans

Understanding PPO and HMO Plans

A PPO plan offers more flexibility when it comes to choosing healthcare providers. You have the freedom to see any doctor or specialist without a referral, both in-network and out-of-network. However, you'll typically pay higher out-of-pocket costs for out-of-network care.

On the other hand, an HMO plan requires you to choose a primary care physician (PCP) who will coordinate your healthcare. You'll need a referral from your PCP to see a specialist, and typically, only in-network providers are covered. HMO plans generally have lower out-of-pocket costs compared to PPO plans.

What to Consider Before Switching

What to Consider Before Switching

Before making the switch from PPO to HMO, there are a few important factors to consider:

  • Network Coverage: Review the list of in-network providers to ensure your preferred doctors and specialists are included.
  • Referrals: Understand the process of obtaining referrals from your PCP for specialist visits.
  • Out-of-Pocket Costs: Compare the cost differences between your current PPO plan and the HMO plan you're considering.
  • Prescription Medications: Check if your current medications are covered under the HMO plan's formulary.
What to Expect When You Switch

What to Expect When You Switch

Once you've made the decision to switch from PPO to HMO, here's what you can expect:

  • Choosing a Primary Care Physician: You'll need to select a PCP from the HMO plan's network. Consider factors such as location, availability, and compatibility.
  • Transferring Medical Records: Contact your current healthcare providers to transfer your medical records to your new PCP.
  • Obtaining Referrals: When you need to see a specialist, you'll need to obtain a referral from your PCP. This ensures that the specialist visit is covered by your HMO plan.
  • Understanding Network Restrictions: Familiarize yourself with the network restrictions of your new HMO plan. Make sure you know which providers are in-network and which are out-of-network.
  • Adjusting to New Processes: HMO plans often have different processes and requirements compared to PPO plans. Be prepared to adapt to these changes.


Switching from a PPO to HMO plan can have its advantages, such as lower out-of-pocket costs. However, it's crucial to carefully consider the network coverage, referral process, and other factors before making the switch. Once you've made the switch, be prepared to choose a PCP, transfer medical records, and adapt to the new processes of your HMO plan.

Get Coverage Plans and Pricing Complete the wizard below to get matched up with health plans and options that meet your needs. (This site is not operational and is currently in development)

What Kind of Health Coverage Are You Looking For?

If you need more info, please check out Help Page.