Health Care Plans: HMO, PPO, EPO, and POS

Health Care Plans

HMO, PPO, EPO, and POS are terms we run across while determining your new type of health plan.  These terms can be confusing to most, making it hard for you to pick the plan that meets your needs.  In this article, I would like to go over all plans and explain how each differs from one another.

HMO Health Care Plans

To begin with, an HMO stands for health maintenance organizations. An HMO covers care inside its own 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 physicians 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 own 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 choose to see a doctor inside your providers “preferred” network, you will be responsible for paying a portion of the total cost. Visiting a doctor or specialist outside your network would also make you responsible for paying those fees. Typically, you would pay a larger portion if you do decide to go out of network but still covered to an extent.

EPO Health Care Plans

Then we have EPO, which means exclusive provider network. An EPO shares similarities to both an HMO and PPO. EPO’s cover prices when using providers only inside of their network, which gives it 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, which is 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 of its plans network.

Since insurance is oftentimes overwhelmingly confusing, we want to shed light on this industry by answering YOUR questions.  So if you have any questions or concerns, comment below and your question may be the topic of our next video!

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