When it comes to the different types of insurance plans, you’re looking at the type of healthcare services that are covered in your plan. You’re also looking at the doctors and facilities you are allowed to see as well. Some plan types let you see any doctor at any healthcare facility. Other plans can limit your choices. They can even charge you more if you use providers outside of the insurance company’s network.
The different plan types include HMOs, PPOs, POSs, and EPOs. Each plan type has a different amount of freedom in choosing healthcare providers.
Health Maintenance Organizations (HMOs)
HMO plans are a type of health insurance plan that limits which doctors you are allowed to see. They typically only allow doctors who are contracted with the HMO network. This plan generally doesn’t cover out-of-network services, except in the case of an emergency. An HMO also requires you to choose a primary care physician to be eligible for coverage. The primary care physician helps coordinate your care. This means they must give you permission before seeing a specialist.
Preferred Provider Organizations (PPOs)
PPO plans are a type of health insurance plan that has a group of contracted providers called participating providers. If you see a participating provider, you will pay less than you would for a doctor who isn’t. You can still see doctors outside of that plan’s network, but you will have to pay more for those services.
Point Of Service (POSs)
POS plans are a type of health insurance plan that allows you to pay less if you use doctors, hospitals, and other providers that belong to the plan’s network. Think of a POS plan as a hybrid between an HMO and PPO. You choose whether you want to use HMO or PPO services each time you go to the doctor. Like an HMO plan, you have to choose a primary care physician. You can pay extra to see non-participating providers like you would with a PPO plan. POS plans also require a referral from your primary care physician to see a specialist.
Exclusive Provider Organizations (EPOs)
EPO plans are managed care plans where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network, except in an emergency. Unlike an HMO, you don’t need to name a primary care physician or get a referral to see a specialist, as long as you choose a ‘participating provider.’
This information will help you decide which of these plans is right for you and your family. For more information regarding insurance benefits, click here.