Don’t know a lot about health insurance? By familiarizing oneself with various policies, a person can make an informed decision when the open enrollment period comes around. This article presents an overview of the most popular health plans on the market.
Preferred Provider Organization (PPO) Plans
The PPO plan encourages individuals to use a network of preferred doctors and hospitals for their medical needs at a discounted rate. This plan doesn’t require individuals to select a primary care provider and allows them to choose any doctor within the network. The plan may include an annual deductible, which must be met before the insurance company covers medical bills. There may be a co-payment for certain services or a co-insurance where individuals are responsible for a portion of the total charges. Seeking medical services outside the network usually results in higher out-of-pocket costs.
Health Maintenance Organization (HMO) Plans
The Health Maintenance Organization (HMO) plan provides a variety of healthcare services via a network of providers that have an exclusive contract with the organization. To receive services, members must choose a primary care doctor and get a referral from their PCP to see a specialist. HMOs offer lower out-of-pocket costs for covered services. Some plans even have no deductibles before coverage begins and low copayments. It’s important to note that HMO plans generally don’t cover services outside of their network without proper authorization from the PCP, except in certain emergency situations.
Point of Service (POS) Plans
The POS group health plan combines the characteristics of HMO and PPO plans. Similar to HMOs, POS plans may require members to select a primary care doctor from the network of providers. Typically, services provided by the PCP, such as routine care or preventative services, aren’t subject to the plan’s deductible. Individuals may receive higher medical coverage if they utilize services provided or are referred by their PCP. However, if they seek services from a non-network provider, they may have to pay upfront, be subject to a deductible, and receive lower medical coverage.
