HMO, PPO, POS, EPO: The Differences among 4 Health Insurance Plans and Network Types

HMO, PPO, POS, EPO: The Differences among 4 Health Insurance Plans and Network Types

Health insurance has many types and services according to the monthly premium you are willing to pay. To get the best benefit from your insurance, you must know exactly what you pay for. You must be very certain that the insurance covers everything you need, especially regarding your preferred medical personnel.
Before deciding which plan you want to purchase, you must know whether your preferred doctor is a part of the insurance network. If he doesn’t, then you must decide whether you want to continue purchasing the insurance or finding another insurance which has your doctor in their network list. You also must know what the consequence is of seeing a doctor outside your insurance network. To help you decide which plan is the best for you, let’s see the differences among all type of health insurance available.

HMO (Health Maintenance Organization)
This plan has lower monthly premium. Unless in the case of emergency, the insurance won’t cover the cost if you decide to go to doctors or medical services outside their network. In HMO plan, you always must visit a primary doctor first for a diagnosis. If you want to see a specialist, you need a reference from the primary doctor.
This system makes HMO has lower monthly premium since the patients don’t need to visit specialist unless it’s really necessary. The primary doctor also will refer the patients to specialist inside their network. This plan is suitable for those who rarely needs medical attention and doesn’t have chronic diseases that needs to be supervised by specialists.

EPO (Exclusive Provider Organizations)
This healthinsurance plan is pretty similar with the HMO. However, you don’t need to get referral to see specialists. You’re only allowed to see in-network specialists. In emergency cases, you can get reference to see out-of-network doctors, but you will be required to pay additional cost.

POS (Point of Service Plan)
This plan offers you more flexibility. You can choose to visit doctors outside your insurance network. However, you will need a referral from in-network primary doctor to see specialists or out-of-network doctors. The price of in-network doctor will certainly be less expensive.

PPO (Preferred Providers Organization)
In this plan, you can choose to go to doctors inside or outside the network. The monthly premium is certainly higher compared to the other types. The insurance will still cover the cost of going to doctors outside their network. However, the coverage cost is lower and you need to pay more out-of-pocket cost. You don’t need a referral from primary doctor to see a specialist or out-of-network doctors if you choose PPO plan. This plan is perfect for you if you want to have a more flexible health insurance.