What You Need to Know About Health Insurance Plans
If you think that the large selection of healthcare plans out there is confusing and overwhelming, you’re not alone. There are many different plans available, which can be difficult to understand. But add in the fact that they all have different policies, providers, and prices, and the situation becomes even more confusing. At present, the four main types of health insurance plans you can get are HMO, PPO, EPO, and POS. Here is basic information on the different types of health insurance plans, along with their similarities and differences.
HMO Health Insurance Plans
The acronym “HMO” stands for “Health Maintenance Organization.” This type of health insurance plan has its own network of medical professionals, including physicians, hospitals, and other healthcare providers. Both healthcare consumers (you) and medical professionals purchase this health insurance plan by agreeing to pay a certain amount for specific services provided. HMO plans are generally a lower-cost plan than most types of health insurance. They tend to have lower premiums as well as lower copay rates and lower co-insurance payments. With an HMO health insurance plan, you are required to have a primary care physician (PCP) and go through him or her to get a referral for any other healthcare provider. The one downside of an HMO plan is that it does not offer out-of-network coverage unless there is an emergency, which means you are limited to in-network providers.
PPO Health Insurance Plans
“PPO” stands for “Preferred Provider Organization.” This type of plan features higher monthly premiums, but it gives consumers the option of using medical professionals who are both in-network and out-of-network. You do not need to go through a primary care physician (PCP) with a PPO to see other doctors. However, you may end up paying more money if you choose to see a provider or a specialist who is out of the PPO network. Referrals are not required for PPO services.
EPO Health Insurance Plans
“EPO” plan stands for “Exclusive Provider Organization.” This type of plan is similar to an HMO plan in the sense that it offers members a lower rate on monthly payments. Unlike an HMO, you do not need to have a referral from your PCP to see a specialist with an EPO plan. However, an EPO plan does not normally cover healthcare service outside of a particular network. This can be an inconvenience if you have a favorite doctor who is not covered under this type of insurance plan. Like an HMO, an EPO health coverage plan is best for people who do not normally see a specialist and who don’t usually make frequent visits to the doctor’s office.
POS Health Insurance Plans
A “POS” plan, or “Point of Service” plan, is a combination of an HMO and a PPO plan. A POS plan is similar to an HMO in the sense that you’ll be assigned a primary care physician. You must go through the PCP in order to see a specialist. However, the difference is that a POS plan also gives you the flexibility to visit a practitioner outside of the network that your PCP is in. You may have to pay a higher price to visit a healthcare provider who is not in your doctor’s network if you go voluntarily. However, the insurance plan usually covers the cost of the difference if your PCP recommends a specialty service from a provider who is not in your network.
With a variety of choices available, choosing a health insurance plan can be difficult. There are many things to consider, including your current health, whether or not you tend to see specialists, and if you have a favorite doctor who may not be included in a network if you switch healthcare plans. Since these plans come with varying monthly payments, you will also have to decide how much you’re willing to spend on healthcare coverage each month.