When you’re looking to choose a new insurance plan, it can be really stressful. Insurance is inherently confusing, and that only makes the plan-selecting process more dreadful. If you’re looking for a new plan, but don’t understand why there’s so many acronyms, we’re here for you. We’re breaking down each type of plan so you can make an informed decision when it comes time to sign a new insurance contract.
Keep in mind that not all plans are the same, even if they are the same plan type. For example, your HMO plan may have different guidelines than your friend’s HMO plan. The best way to fully understand your plan’s benefits is to contact your insurance company directly.
HMO - Health Maintenance Organization
In summary, an HMO will most likely require you to have a PCP and a referral every time you go to a specialist (except in the case of emergency). This means you might have to find a PCP you’re really fond of. Also, they won’t help you with the bill if you see an out-of-network provider. These restrictions are part of the reason why these plans normally have lower monthly premiums.
PPO - Preferred Provider Organization
Overall, PPO’s usually have providers that they’d prefer you use, but will still assist you if you need to see an out-of-network provider. You’ll also have a little more freedom over your health decisions, and won’t need to consult a PCP before going to a specialist. These are reasons why the monthly premiums tend to be higher.
EPO - Exclusive Provider Network
In sum, EPO’s usually have providers they use exclusively. If you go to a provider that’s not on their list, they probably won’t help you with the bill. On the plus side, they most likely won’t make you get a referral or visit a PCP before visiting a specialist.
POS - Point of Service
In most cases, POS plans will require you to have a referral and a PCP, but may help you out if you see an out-of-network provider.
At the end of the day, the insurance plan you pick for yourself or your family may not be the plan your neighbors or coworkers pick, and that’s okay. When choosing a plan, it’s important to understand your circumstances and respond accordingly. As long as you’re making an educated decision, you’ll be on the right track.
If you are experiencing a life threatening emergency please call 911 or go to the nearest emergency room