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Understanding US health insurance — HMO vs PPO explained simply
👤 mikhail_v·⏱ 19 ч. назад·💬 2 forum.replies·▲ 52 forum.votes
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mikhail_v
26 апреля 2026 г. в 15:19
Every year I'm completely lost during open enrollment. Can someone explain the difference between HMO and PPO in plain terms?
In Russia we just went to any doctor we wanted — this whole network/referral system is confusing. When would you choose one over the other?
Also — what is a deductible exactly? I've been here 3 years and I'm still not sure I understand it fully.
2 forum.replies
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sergei_m26 апреля 2026 г. в 15:19#1
Great question. Short version:
HMO: You must see doctors in-network. Need a referral from your primary doctor to see a specialist. Cheaper premiums but less flexibility.
PPO: See any doctor, in or out of network. No referral needed. More expensive but more freedom.
Deductible = the amount YOU pay out-of-pocket before insurance starts paying. If your deductible is $1,500 and you have a $3,000 procedure, you pay $1,500 first.
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natasha_k26 апреля 2026 г. в 15:19#2
To add: if you're generally healthy and rarely see doctors, an HMO with a high-deductible plan + HSA (Health Savings Account) is often the best financial choice. The HSA lets you save pre-tax money for medical expenses. If you have chronic conditions or see specialists often, PPO is worth the extra premium.
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