Health Insurance Articles
The Difference Between HMO, PPO, And POS
2010-02-02
Determining which healthy policy is best for you is a question that many first time policy holders ask themselves when they are looking at buying health insurance. There are several insurance plans that an individual can have. One form of insurance is the managed care providers, also known as the in-network providers. These forms of insurance limit the number of possible physicians the patient can choose from for a reduced price. Three of the in-network provider plans include the Health Maintenance Organization plan (HMO), the Preferred Provider Organization plan (PPO), and the Point of Service Plan (POS). Each plan has key features that help to serve each individual policy holders needs.
The Health Maintenance Organization plan or the HMO plan entails that the primary care physician manages the patients' care completely, leaving minimal work and no hassle for the patient. Referrals are necessary when specialists are needed, except in emergencies. With an HMO plan, a monthly or quarterly fee is required in addition to the co-pay that is applied when care is given.
With the Preferred Provider Organization plan the patient is free to choose a physician or specialist without referral from an in-network list of doctors. The patient can, however, choose a physician from outside the network if they wish to do so. With the PPO plan, the patient would have a yearly deductible that would be paid out-of-pocket before any medical fees were paid by the insurer; there is also a co-payment due at every service appointment.
The Point of Service plan is a combination of both the HMO and PPO plans with no deductibles and minimal co-pays. With the POS plan, the patient has the option to select their own primary care physician from within the network provided who then refers the patient to specialists if needed. The patient has the opportunity to provide their own specialists just like the PPO plan does. The only difference is that when this is done, the patient is then responsible for their own paperwork and billing. They must also submit their claims themselves. Just like the PPO plan, it is more expensive to use an out-of-network provider and the out-of-pocket cost would be considerably higher.
Whether you're looking for a yearly premium or a monthly bill, the health insurance coverage that you are seeking is out there and could fall under one of these network provider plans. The HMO can provide stability, the PPO can provide choices, and the POS can give you the option to have a little of both. If you want to keep the doctor you've had, or you don't mind finding another one, each plan has specific details that help to ensure the best policy for you.
