Exclusive Provider Organization (EPO) is a health care plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within a certain network. This means if you see a doctor or a specialist outside the network, your medical plan will not cover it. EPO insurance rates are generally lower than other types of health care plans. EPO insurance can give you direct access to in-network specialists. With an EPO plan, members are not required to get a referral from their primary care physician before seeing a specialist. Unlike other types of health insurance plans, EPOs do not require members to have a primary care physician. This allows more freedom to see different doctors and hospitals that are in-network. EPO insurance allows you to get emergency care from out-of-network providers without being penalized. Although EPO insurance members are not able to see out-of-network healthcare providers without paying for it out-of-pocket, they can receive emergency services from doctors or hospitals that are out-of-network.
Health Maintenance Organization (HMO) gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. Care under an HMO plan is covered only if you see a provider within that HMO's network. Advantages of using HMO insurance are lower monthly premiums and generally lower out-of-pocket costs and lower out-of-pocket costs for prescriptions. Another advantage of HMO is the convenience of having a primary care doctor as your advocate to coordinate and manage your care.
Point of Service (POS) is a type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. A POS plan may provide services at a lower overall cost, but with fewer choices. These plans also require you to get a referral from your primary care doctor in order to see a specialist. Services rendered by a primary care physician are typically not subject to a deductible and preventive care benefits are typically included. participants can choose to receive care from non-network providers, but this comes at a greater out-of-pocket expense and may require co-payments. POS may be a good fit for those who live in rural areas as they may have fewer choices with an HMO in small towns.
Preferred Provider Organization (PPO) provides more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. PPOs insurance allows participants to see any doctor facility in their network without a referral. Out-of-network benefits also allow participants to see providers outside the network, but at a cost. You are also able to choose specialists without consulting a primary care physician and can be admitted to any hospital or facility of their choosing. PPO allows you to choose your provider, but the full rate for physicians and hospitals outside the network can be quite costly.
