PPO, HMO, EPO…oh no! Most people agree that discussing health insurance options leads to a headache.
That could be the reason why 44 million Americans do not have health insurance, and an additional 38 million have inadequate healthcare coverage.
Why is choosing between healthcare plans in America so confusing? Most of the time, people don’t understand the diverse options available to them. The key to picking the best healthcare plan is to understand all of the alternatives.
Let’s explore the different types of health insurance, so you can determine which one is best suited for your lifestyle.
Types of Health Insurance: HMO
HMO, which stands for Health Maintenance Organization, is a type of health insurance that provides customers with services from a designated network of providers. People with an HMO plan are typically covered for a broad range of preventative healthcare services.
With an HMO, you may choose a primary care physician (PCP) who will take care of your general healthcare needs. If you require additional care from a specialist, such as an OBGYN or cardiologist, your PCP will refer you to a provider within your HMO plan.
HMO health insurance features minimal co-payments and low out-of-pocket expenses. It is a good plan for those looking for extensive preventive care coverage.
However, patients should keep in mind that HMO services are limited to a specific medical network. If you seek healthcare from a provider not listed in your HMO network, it will not be covered by your insurance provider.
Short Term Plan
Short term health insurance is a temporary health insurance plan for people who need coverage. It’s designed for those in a period of transition or for patients who do not qualify for other healthcare programs.
Temporary health coverage is ideal for people who are:
- Turning 26 and being removed from their parent’s health plans
- Between jobs or waiting for benefits to kick in at a new job
- Looking for coverage before qualifying for Medicare
- Waiting for healthcare from the Affordable Care Act to start
- In good health and under the age of 65
Coverage begins as quickly as the day after the user applies.
This type of health insurance allows people to pick their deductible, the length of coverage, and drop the plan whenever they need to. It gives people access to an extensive network of physicians with affordable premiums.
Many short term plans can range from one to 12 months. The insurance does not have coverage requirements, so users must pay attention to their plan’s details.
Short term health insurance does not cover pre-existing conditions. However, most plans cover basic health services and provide insurance during hospital stays. When applying, users must answer a medical questionnaire to qualify for coverage.
PPO
PPOs are popular types of health insurance plans for families and individuals. PPO stands for Preferred Provider Organization. It allows users to visit any in-network medical provider without a referral from a primary care physician.
When you enroll in a PPO health coverage plan, the insurance provider will supply you with the company’s list of preferred medical professionals. As long as you visit the doctors and specialists on this list, you will not need a primary physician or referral.
In addition, PPO plans will cover a portion of a person’s out-of-network health coverage. The patient will have to pay a higher deductible and make co-payments, but the insurance company will help fund the expense, unlike HMO providers.
PPO plans are ideal for people who do not have or want a primary physician. This type of insurance is best for people who want the freedom to choose their doctors, wish to have the option of going outside their network, and do not want to obtain referrals.
POS
Point Of Service (POS) is one of the most popular types of healthcare insurance plans because it’s a combination of HMO and PPO plans.
Similar to an HMO, patients must choose a primary physician who will refer them to in-network physicians as-needed. The plan covers a wide range of preventative services and immunizations.
Like a PPO, a POS health plan allows patients to receive care from non-network providers at a greater-out-of-pocket cost. Policyholders may have to make co-payments during their visits and pay an annual deductible.
POS healthcare plans are ideal if you can work with healthcare providers and hospitals within your plan’s network. They are also good for people who want the option of going out of their network and can afford to foot the majority of the bill.
EPO
Exclusive Provider Organization (EPO) healthcare plans offer users a local network of medical professionals and hospitals to choose from. The EPO will cover medical experts within their plan. If you visit a doctor outside of your network, EMOs will not provide coverage.
However, EPOs will make an exception in emergencies. If a user visits a non-network hospital for life-threatening injuries, the insurance provider will still cover the stay.
EPOs do not require referrals. As long as the provider is part of the provider’s network, patients may see them.
EPOs are similar to HMOs because they cover in-network providers. However, EPO networks are often larger than HMO networks, giving patients a better variety of medical professionals to choose from.
As far as price goes, EPOs generally have higher premiums compared to HMOs, but they are less expensive than PPOs.
Explore More Health-Related Topics
Between short term plans, HMOs, PPOs, and all of the other types of health insurance, it’s common to feel overwhelmed with the different healthcare choices.
But the more you know, the easier it is to choose the most effective healthcare plan for you and your family.
Are you looking to explore more health-related topics? If so, you’re in the right place. Browse our blog now to learn about nutritious diets, weight loss tips, motivational quotes, and more.
