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HMO, PPO, and POS differences?

HMO, PPO, POS DifferencesDo you know the difference between a PPO, an HMO, and a POS? If so, congratulations are in order. Most people have only a vague idea. While all are types of health insurance coverage, they contrast in ways that may not mean a lot to you until you find yourself faced with an unexpected medical bill. That’s when a little knowledge can go a lot further than you thought.

Health Maintenance Organizations

Known to most as an HMO, the health maintenance organization offers its participants a list of preferred providers from whom it expects them to obtain every piece of their medical care. From this roster of doctors, medical facilities, and other health care resources, the plan wants you to select an internist, general practitioner, family physician or pediatrician to serve as your primary care physician and satisfy the bulk of your medical requirements. When the need for more focused treatment arises, he will provide the recommendation you’ll need to see a specialist.

That need for a referral is one of the HMO’s most significant features. Unless and until you’ve obtained one from your primary care physician, the plan will not pay for any specialized care. Despite this black mark, however, the HMO is not without its plusses. For one thing, those who participate need never file a claim. Although a modest copay is standard, the plan will reimburse your provider directly up to the limits of what it considers reasonable. If your HMO should deem the charges too high, you yourself must make up the difference.

Point-of-Service Organizations

The POS is a special type of insurance plan that combines the standard features of an HMO with those offered by a PPO. This type of plan gives you options. If you wish, you can go the standard HMO route of choosing an in-house primary care physician and seeing only the specialists to whom he refers you. This way will always be the least expensive.

There is generally a Tier 2 benefit which is closer to the PPO Network. And then finally there is the Out of Network option where you will typically have to pay either a much higher copay, a percentage of the bill, or in some cases have to meet your deductibles first. You can also see a specialist without a referral.

Preferred Provider Organizations

Many think of the PPO as the Cadillac plan. It is without question more flexible an HMO or a POS.

  • It contracts with a larger lineup of providers. In some cases has a nationwide network.
  • It demands no referrals before seeing a specialist.
  • Its providers can belong to any number of assorted HMOs or PPOs.

When they receive services from an in-network provider, PPO patients who do not benefit from a discounted fee arrangement will alternatively make a relatively small copayment up front. However, any participant who doesn’t mind paying extra can always seek care from an out-of-plan provider. This flexibility makes the PPO attractive to many.

Indemnity Health Plans

Difficulty in controlling rising costs has caused the traditional indemnity plans, once a staple of the health care industry, to suffer a significant drop in popularity. Nevertheless, many still appreciate their old-time flexibility. As a participant in this type of plan, you can choose when, where and from whom you wish to receive your medical services.

Indemnity plans will either pay the provider outright or reimburse you after you have filed a claim. While they spell out a laundry list of covered services, they also enumerate in detail their limitations and outright exclusions.

Simplify Your Health Insurance Worries

Although the various types of health insurance plan may seem confusing, you don’t have to make your selection alone. With All Kinds of Insurance at the ready, you can leave the work of finding the perfect coverage to the experts. Call 702-534-4697 and let us do the legwork for you. You’re sure to be glad you did.