Have you been selecting a health insurance plan from an overwhelming number of choices? With every type of health insurance plan, comes in different benefits and coverage options with various levels of flexibility. You need to know the differences between these plans in order to take an educated decision. Use this map to get through the top four provider network models in health insurance: HMO, PPO, EPO and POS.
1. HMOs (Health Maintenance Organizations)
One of the most popular types for people because it highlights prevention and lower prices is an HMO (Health Maintenance Organization) plan. HMOs: An HMO requires that you select a primary care physician (PCP) who functions as your main healthcare provider. The PCP (Primary Care Provider) is the one who puts together everything that has to do with your health; he or she sends you with a specialist. To start, HMO plans have lower out-of-pocket costs which makes it a sensible choice for individuals or families paying out of pocket.
Key Features of HMO:
Need a PCP (Primary Care Physician) to coordinate your care.
Specialist advice requires referrals.
Most lower premiums and out-of-pocket costs.
Restricted to a network of providers
Who It Serves: HMOs work best for people or families who are fine with having one doctor in charge and want to keep health costs down.
2. Or face attack the tomorrow of HMOs or PPO?
PPO Plan: A Preferred Provider Organization (PPO) plan provides more flexibility than an HMO. PPOs don't require that you have a primary doctor, and allow you to see specialists without a referral. PPO plans PPO coverage is more flexible, as it allows a certain percentage of out-of-network treatment depending on the plan at additional cost. Such flexibility is why PPO plans are typically more in demand by the individual who wishes to have a greater autonomy over their healthcare decisions.
Key Features of PPO:
No primary care gatekeepers, specialists accessible without referrals.
Network coverage and out-of-networketAddress
Premiums and out-of-pocket costs are higher than HMO plans.
More provider choice
Who It Matches: A PPO is best for someone who appreciates the option to select their medical professionals and specialists yet does not wanna hardly any extra for this flexibility.
3. EPO (Exclusive Provider Organization)
A type of plan that is a hybrid between an HMO and a PPO is called an EPO, or Exclusive Provider Organization. An EPO, like an HMO, requires you to use a health providers for your care. Unlike a HMO, though it operates similarly to a PPO — you do not need as referral in order to see a specialist. Like PPOs, EPOs generally have lower premiums than HMO plans but the companies do not pay for care that is outside of their network unless it's an emergency.
Key Features of EPO:
No specialist referrals required.
Must be done by providers in the network, except for emergencies.
Better rates than PPOs with some restrictions
CON: Limit (to in-network managed care)
Best For: EPOs are great for people who want to go see a specialist without referrals and do not need out-of-network coverage.
4. Point of Service (POS)
POS: A Point of Service (POS) plan is a hybrid between an HMO and PPO. POS Instead of an HMO, with a POS you select one main physician to handle your care and refer out. But much like a PPO, with POS plans you are still covered when receiving care outside of the network—just at an additional price. POS plans tend to have smaller networks than PPOs but offer fewer restrictions as compared with HMO.
Key Features of POS:
Requires a PCP for referrals.
Provides out-of-network coverage, but at reduced rates.
Benefits from both Cost saving and Flexibility.
In general, premiums tend to be lower than PPOs
Who It Provides The Best Coverage for: POS plans are great if you want a split between the savings of an HMO and more freedom that comes along with PPO.
Conclusion
Differences between HMO, PPO, EPO and POS Health Insurance Plans All plans are a mix of low costs, high coverage and flexibility configurations. You can choose the right one by carefully considering a few factors to make an informed choice and end up in receiving best care for you as well as your family.
The importance of comparing your health insurance options to make an informed choice about what plan is best for you based on your individual needs and likes.
0 Comments