Health Care Plans
HMO, PPO, EPO, and POS are terms we run across while determining your new type of health plan. These terms can confuse most people, making it hard to pick the plan that meets your needs. In this article, I would like to go over all the plans and explain how each one differs from the others.
HMO Health Care Plans
To begin with, an HMO stands for health maintenance organizations. An HMO covers care inside its network. You will be given a list of primary care physicians who will take care of all your basic health needs, such as checkups. If you need to see a specialist, your primary care physician must give you a referral. You would also be provided a specialist under your HMO’s umbrella. If you choose to see a different doctor outside of your plan, those costs will usually come out of your pocket.
PPO Health Care Plans
Next, we have PPO, which stands for preferred provider organizations. The health plan provides you with a preferred network but doesn’t limit you to choosing a primary physician, nor do you require a referral. If you decide to see a doctor inside your provider’s preferred network, you will be responsible for paying a portion of the total cost. Visiting a doctor or specialist outside your network forces you to be responsible for paying those fees. Typically, you would pay a larger portion if you decide to go out of network but remain covered to an extent.
EPO Health Care Plans
Then, we have EPO, which means an exclusive provider network. An EPO shares similarities to both an HMO and a PPO. EPOs cover prices when using providers only inside of their network, which gives them the qualities of an HMO. Like a PPO, you do not need a referral to receive care from a specialist. You will be responsible for paying the cost if you decide to go outside your network.
POS Health Care Plans
Finally, we have POS, a hybrid of HMO and PPO plans. POS stands for point of service. Like HMO plans, to see a specialist, you would need a referral from your primary care physician. POS plans can also give coverage for out-of-network care at an increased cost. With POS, you would also pay less to use doctors and hospitals inside its plans network.
Choosing the Right Health Care Plan
Now that the differences between HMO, PPO, EPO, and POS plans have been laid out, it is important to consider personal healthcare needs and budget restrictions when choosing a plan. Here are a few key factors to keep in mind:
Provider Network: Finding doctors and specialists that you cherish and feel comfortable with can be a difficult feat. So, you want to ensure they remain in-network when shopping around for a new plan.
Referrals & Flexibility: Testing out new specialists without needing referrals can be a must-have for some. If that is the case, a PPO or EPO plan could be your best bet.
Out-of-Network Coverage: If you spend more time traveling than at home, you may want to look into a PPO or POS plan for more flexibility in choosing providers.
Cost Considerations: Then, of course, you want to study monthly premiums, deductibles, and copays to find a balance between what you can afford and the coverage you need.
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This article was updated on 1/20/2025.