HMO, PPO, POS: What"s the Difference?
Health insurance can be a confusing topic.
While we do the best we can, a lot of us probably just nod our heads and sign the paperwork that our HR department puts in front of us.
It's best that you understand your options.
Here are the basics on three health insurance plans: HMO Most Americans who are insured have some form of managed care.
HMOs, or Health Maintenance Organizations, are probably the most well-known...
at least by name anyway.
A perceived downside of an HMO is that you have to choose your doctor and other health providers in your HMO network.
The negative is that you are restricted in your choices.
Your primary doctor will coordinate all of your medical care.
That means if you need to see a specialist, such as a dermatologist or psychologist, they will write a referral for you to see them.
So, where is the upside with an HMO, you ask? Well, the benefit to HMO is that it's usually less expensive than other options.
Patients don't have deductibles in HMOs and the co-pay is usually very reasonable.
Lastly, preventative measures, such as yearly check-ups, are covered by the HMO.
PPO PPOs, or Preferred Provider Organizations, also have pre-approved lists of healthcare providers who are referred to as participating or in-network healthcare provides.
The main reason people like PPOs is that they also allow for the insured to choose from doctors and other healthcare professionals outside of this network.
Just remember that when you use a non-participating provider you will be paying more for that privilege.
Another positive to being in a PPO is that if you need to see a specialist, you don't need a referral from your primary doctor.
However, there are negatives.
PPO plans cost you more in the deductibles, co-insurance and other out-of-pocket expenses.
The co-insurance is a percentage that you pay after your policy's deductible is exceeded up to the policy's stop loss.
POS A POS, or Point-of-Service plan, is a bit like a blend of the HMO and PPO.
Like the HMO, you must select a primary physician.
However, you also have the choice to go out of your network like in a PPO.
If you stay within the network, your copayment and deductibles are small.
Now that you armed with a little basic information on the most popular health plans, you can feel a little more comfortable when you need to speak with the benefits coordinator in your company about what direction is right for you.
While we do the best we can, a lot of us probably just nod our heads and sign the paperwork that our HR department puts in front of us.
It's best that you understand your options.
Here are the basics on three health insurance plans: HMO Most Americans who are insured have some form of managed care.
HMOs, or Health Maintenance Organizations, are probably the most well-known...
at least by name anyway.
A perceived downside of an HMO is that you have to choose your doctor and other health providers in your HMO network.
The negative is that you are restricted in your choices.
Your primary doctor will coordinate all of your medical care.
That means if you need to see a specialist, such as a dermatologist or psychologist, they will write a referral for you to see them.
So, where is the upside with an HMO, you ask? Well, the benefit to HMO is that it's usually less expensive than other options.
Patients don't have deductibles in HMOs and the co-pay is usually very reasonable.
Lastly, preventative measures, such as yearly check-ups, are covered by the HMO.
PPO PPOs, or Preferred Provider Organizations, also have pre-approved lists of healthcare providers who are referred to as participating or in-network healthcare provides.
The main reason people like PPOs is that they also allow for the insured to choose from doctors and other healthcare professionals outside of this network.
Just remember that when you use a non-participating provider you will be paying more for that privilege.
Another positive to being in a PPO is that if you need to see a specialist, you don't need a referral from your primary doctor.
However, there are negatives.
PPO plans cost you more in the deductibles, co-insurance and other out-of-pocket expenses.
The co-insurance is a percentage that you pay after your policy's deductible is exceeded up to the policy's stop loss.
POS A POS, or Point-of-Service plan, is a bit like a blend of the HMO and PPO.
Like the HMO, you must select a primary physician.
However, you also have the choice to go out of your network like in a PPO.
If you stay within the network, your copayment and deductibles are small.
Now that you armed with a little basic information on the most popular health plans, you can feel a little more comfortable when you need to speak with the benefits coordinator in your company about what direction is right for you.
