Health Insurance Plans Spelled Out

 

HMO vs. PPO and more

Health insurance plans are often written as acronyms like HMO and PPO. It can be hard to remember what they all mean. Different types of health insurance plans have different rules, and these rules may impact which doctors you can see, prior authorization, and out-of-pocket costs. Some plans have lower monthly premiums but higher deductibles, whereas others have higher monthly premiums with lower deductibles.

Understanding the benefits available under different types of health insurance plans can help you make informed decisions for you and your family. Here’s a breakdown of different health insurance plans and the meaning behind the acronyms.

HMO

A Health Maintenance Organization (HMO) plan has lower monthly premiums, but it limits your healthcare coverage to a local network of doctors contracted with the HMO. It does not include coverage for out-of-network care except in the case of an emergency. It requires a referral from your primary care provider (PCP) to see a specialist.

PPO

A Preferred Provider Organization (PPO) plan offers more flexibility and choice in your healthcare providers and services, but it has higher monthly premiums. It offers coverage for providers who may be in or out of network, though cost sharing may be higher for out-of-network care. It does not require a referral to see a specialist.

EPO

An Exclusive Provider Organization (EPO) plan limits coverage to a local network of doctors that is generally larger than HMO networks. It does not include coverage for out-of-network care except in the case of an emergency. EPOs have higher monthly premiums than HMOs but lower than those of PPOs. It may not need a referral to see a specialist.
 

POS

A Point of Service (POS) plan has similar coverage to that of an EPO or HMO but may offer limited out-of-network flexibility. Costs will be higher for out-of-network care than in-network care. It requires a referral from your primary care provider (PCP) to see a specialist.

Some questions to consider in deciding the right plan for you may include:

• What does the plan cover and can I get the services I need?
• Will I have to change doctors?
• How much flexibility do I want in choosing a doctor?
• Are my prescriptions covered?
• Can I afford to pay my premiums and out-of-pocket costs?

To learn more about insurance terms like ‘premiums’ and ‘out-of-pocket costs’, see our article, “Handy Health Insurance Definitions”.

For any questions you may have about health insurance plans or navigating the healthcare system, your CareConnect team is just a phone call or email away. Call 1-800-745-4447, option 3, or email info@CareConnectPSS.com.