If you have a complex concern requiring lots of testing and a more flexible doctor, it seems like PPO’s are a better choice over HMO’s due to monetary incentive structure. I found this rarely mentioned when discussion PPO vs HMO’s pro’s and con’s.

That is because HMO doctors are frequently paid based on capitation, or number of patients they see, regardless of number of visits. PPO doctors are paid based on services provided, such as tests and procedures.

I found this rarely mentioned when discussing PPO vs HMO’s pro’s and con’s to newbies such as myself when I was first looking into insurance out of college. I wish I knew this back then. I thought the only big differences were which doctors I could see and having to see a PCP first to get authorization, as mentioned in the links below. Looking back and having had both PPO and HMO, that definitely wasn’t the most important thing to me. Quality of care in terms of wait times, ability to get a diagnostic test or procedure, and less rushed doctors were far more important to me. And these were all noticeably better on PPO for me.

e.g top results from a quick Google search:

HMO is extremely inticing considering the premiums are far smaller. However, when factoring plausible differences in the quality of care aspects I mentioned above, I think it would change the situation for those that have a complex concern or simply want more from their doctors.