Types of Medical Insurance Plans

We present to you four types of medical insurance plans and their main features. Some of them require to select a Primary Care Physician, others don’t. Some of them require referrals, others don’t. For some you need to file claim paperwork, for others you don’t. All these influence the cost sharing level.

HMO plans

HMO stands for health maintenance organization. The HMO plans require one primary care physician. Whatever health care services you may need you must go through that doctor. It means that you need a referral before you see other health care professional. However there is an exception for this – the case of an emergency. If you visit health care professionals that are out of your network then you will need to pay extra money because these visits are not covered by your insurance. If something happens to you for example if you get a skin rash you should first consult your primary care physician. After he will examine you and he can’t help you then he will redirect you towards a trusted dermatologist in your network that can help you. However there is one exception from this rule for women that need a gynecological consult in their network for routine services from time to time such as Pap tests or annual well-woman visits.

  • You will have the least freedom to choose your health care providers
  • You will have the least amount of paperwork – for the visits to your primary care physician you will not have to do any paperwork or pay any extra money.
  • You will have predictable out-of-pockets costs

PPO plans

PPO stands for preferred provider organization. PPO medical insurance plans don’t use a primary care physician. You will be able to go to any health care professional you want without a referral no matter if your health care professional is inside or outside of your network. Inside the network you will have smaller copays with full coverage. If you choose to get medical services from outside your network then you will need to pay more money and you may encounter the situation when not all the desired services may be covered. The big advantage that the PPO plan brings over the HMO plan is that you will have more control over the quality of the health services that you will get  because you will be able to select the doctors that you will see.

EPO plans

EPO stands for exclusive provider organization. These medical insurance plans combine the flexibility of PPO plans with the cost-savings of HMO plans. The beauty of this type of plan is that you won’t need to choose a primary care physician, neither need referrals to see a specialist. It’s very important to know who are the doctors that belong to your EPO plan’s network because if you go to a hospital that doesn’t accept your plan you will have to pay all the costs.

POS plans

POS stands for point-of-service plan. A POS plan is a blend between a HMO plan and a PPO plan. The doctors that you can see after you have chosen this plan are both inside your network and outside your network. It means that you will pay a higher deductible if you will see a provider that’s out of your network. The POS plan is similar with the HMO plan because you will have a primary care doctor who will coordinate your care. You will have a little paperwork to do too compared with other plans. The premium choice for a POS plan is generally lower than a PPO plan.