Plans bought through Preferred Provider Organizations, Health Maintenance Organization, Exclusive Provider Organization, Point of service, and Fee for service are the five basic types of health insurance plans.
There are five general types of health insurance plans. Each have their pros and cons. Insurance agents sometimes use health insurance leads to help them figure out which plan is the best for their client. But, as a smart insurance buyer, you need to do your part and understand what the types are before making a decision.
Health Maintenance Organization (HMO)
One of the most common types of health insurance is Health Maintenance Organization. Most U.S. workers have an HMO because that is the only thing their company offers. HMOs are the most affordable type of insurance plan and may include preventive care, dental care, and eye care in its coverage. A broad network of doctors, specialists and healthcare facilities are provided to the policyholders of HMO. Policyholders decide on a primary-care physician who will guide all healthcare services and medical needs necessary. The physician is sort of like a gatekeeper in this aspect. An HMO covers expenses only when the patient’s primary care doctor refers him or her to a medical service or a specialist. Being the most restrictive type of healthcare plan, is the downside of an HMO plan. In accordance with the plan stipulations, a co-pay may be necessary for the patient to make a visit to a clinic.
Preferred Provider Organizations (PPOs)
A PPO does not require you to get referrals. You should know that it is cheaper if you pick the health care providers and services that are listed as being within your own PPO’s network. It would require the insured to pay 20% of the total costs while the remaining 80% is covered by the PPO, for services and facilities sourced from outside the network, and are more expensive.
Exclusive Provider Organization (EPO)
Exclusive Provider Organizations, or EPOs, are nearly similar to PPOs, however have a distinctly smaller network. Unlike PPOs, EPOs normally do not offer coverage for services rendered by specialists outside their own network.
Point of service (POS)
Health insurance plans that fall under a point of service type is similar to PPOs in that they also have a primary-care physician. Though it is more expensive and requires additional paperwork to be complied, they also allow the insured to seek services from healthcare specialists outside its own network.
Fee for service (FFS)
The type of health insurance plan that is least restrictive and offers a wider range of choices of medical specialists and facilities is the Fee for services. If you have a policy that is fee for service based you can choose the health care provider and facility you want. Before the insurance provider gives money for these services, the insured has to pay a preset deductible amount. Even when insured you will have to pay 20% out of your pocket for every service. Stipulated in the insurance contract is the maximum amount required to be paid by the insured.
Unfailingly make a complete overview of your coverage needs and your financial possibilities when deciding on a health insurance plan. Strive to balance the before mentioned aspects to get the plan best fitted to your situation.