COVERAGE OPTIONS: Top health plan types

November 13, 2020

PPO or “Preferred Provider Organization” plans are the most popular with Individuals and Families. As the name implies, with aPPO you’ll get your medical care from doctors or hospitals on the insurance company’s list of preferred providers. It’s up to you to make sure that the health care providers you visit participate in the PPO you select. It’s important to note that services rendered by out-of-network providers may not be covered at all or are paid at a lower level.

How does a PPO plan work?

Here’s how it works: Healthcare providers are contracted with specific health insurance companies to offer plan members a discounted rate. Typically, you will be able to see doctors and specialists within the network

at your own discretion. It’s likely there will be an annual deductible you must pay before the insurance company starts covering your medical bills. Certain services may also require a co-payment or you may be required to pay a certain percentage of the bill. It will all depend on the specific plan you select.

What is a PPO plan?

A PPO plan may right for you if ?

  1. Your favorite doctor already participates in thePPO.  After getting quotes, sort through plans accepted by your doctor.
  2. You want some freedom to direct your own healthcare and don’t mind working within a list of preferred providers.

What’s an HMO and how does an HMO work?

HMO means “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that arec ontracted, or who agree to provide services to members. Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital. As a member of an HMO, you’ll be required to choose a primary care physician (PCP), for most of your healthcare needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.

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A HMO plan may be right for you if:

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  • You’re willing to play by the rules andcoordinate your care through a primary care physician
  • You value preventive care services: coverage forcheckups, immunizations and similar services are often emphasized by HMOs

What is a POINT of SERVICE (POS)?

A POS (Point of Service) plan is a hybrid of HMO and PPO plans. As with an HMO, members of a POS plan may be required to choose a primary care physician from the plan’s providers. Physician visits may/may not be subject to a deductible. Like HMOs, POS plans typically offer coverage for preventive care visits.

Please note this information may vary by insurance company.
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