From the state’s marketplace to private insurance companies, people shopping for health insurance have plenty of options. Those under 30 may also be able to purchase a high-deductible, catastrophic plan. Wondering how these plans differ? Here’s a breakdown.
Health Maintenance Organization (HMO)
An HMO plan delivers healthcare services via a network of local health providers and facilities. This type of plan requires policyholders to choose a Primary Care Provider from the existing network. The PCP would be one’s home base for any sort of medical care. If one needs to see a specialist, the PCP will need to provide a referral. The cost for an HMO plan, including coinsurance and copays, is usually lower than that of other health plans, provided one stays in the network.
Exclusive Provider Organization (EPO)
EPOs offer a network of participating healthcare providers to choose from. Typically, EPO plans do not offer coverage for out-of-network care unless in the case of an emergency. This means that if a policyholder visits a facility or physician outside the plan’s network, they will likely have to cover the entire cost of the services themselves. Depending on the plan, one may or may not be required to pick a Primary Care Provider. Unlike HMOs, PPOs don’t require policyholders to have a referral to see a specialist.
Point-Of-Service Plan (POS)
A point-of-service plan combines the features of a PPO and an HMO plan. The provider network, in this case, is usually smaller than that of a PPO plan, but the costs for in-network healthcare services are usually lower. POS plans require policyholders to pick a Primary Care Provider (PCP) from within the network. People who want to see a specialist need to get a referral from their PCP. However, one can choose to visit specialists that are out of the network or in the network. If one sees doctors outside the network, they will be responsible for filing claims themselves and will incur higher costs.
Preferred Provider Organization (PPO)
PPOs offer a pretty large network of participating providers, so one may have a lot of hospitals, doctors, and other healthcare facilities and professionals to choose from. One can also choose to see healthcare providers who are not part of the network, but the out-of-expenses will be higher in this case. Policyholders are not required to choose a Primary Care Provider with this plan.