Can you explain the meaning of the different health insurance plans? (HMO, PPO, POS, etc.)

UPDATED: Oct 9, 2012

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Asked October 9, 2012

1 Answer

It can be confusing trying to pick a health insurance plan from a list of acronyms. Each type of plan provides you with unique benefits, and it is important that you know what kind of plan you are being offered, both because all plans include their own out of pocket expenses. Review a quick list of the most popular health insurance plans, and if you have a choice, pick the one that most closely matches the needs of your family.

HMO is short for Health Maintenance Organization. In this type of plan, you have a primary physician who determines your health needs and refers you to specialists as needed. Your choices are limited to caregivers that operate within the HMO network and you are responsible for the costs related to any out of network care you receive. An HMO is considered a health maintenance plan because it is focused on preventive care to reduce medical costs.

PPO is an acronym for Preferred Provider Organization. It is very similar to an HMO, but does not include a primary physician who manages your health needs. Additionally, PPO plans will let you see caregivers who are not part of your health plan's network, but you will have to pay the difference between your insurance coverage

POS, or Point of Service, is a plan which allows you to choose providers outside of your network if you are willing to pay the difference in cost between caregivers in the plan and the provider you have chosen. Visiting out of network doctors may also have fees that must be paid in addition to other health insurance costs.

Independent Provider Organizations, IPO's, are similar to an HMO as well. The biggest difference in this type of plan is that it costs you more out of pocket, and you are not limited to choosing physicians or caregivers who are in your health insurance plan's network.

There are other distinguishing characteristics of the different health plans, but the primary differences are always going to be based on where you can get care, what you have to pay for it, and whether or not you are allowed to decide when specialist care is needed When selecting a health insurance plan, you should be taking each of these into conisderation.

Answered October 9, 2012 by Anonymous

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