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Health Insurance Basics
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The three most common types of health insurance available are HMO, PPO, and POS |
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A HMO health insurance plan is the least expensive, but it is also the least flexible. With an HMO plan, you pay a fixed monthly fee for a range of health benefits such as doctor’s visits, preventive care, and hospitalization. Usually there is no additional cost, except a nominal co-payment per office visit (usually around $10-$25). However, you must choose a primary care physician (PCP) from the plan’s list and whom you must visit when you are sick. If you need any treatment from a specialist, you must obtain a referral. Your PCP will determine to which specialists and to what hospitals you may be referred. With most HMOs, the insurance provider may not substantiate the claim if you fail to obtain a referral prior to visiting a specialist or if you visit other physicians outside of the HMO health insurance network (except for emergency care). |
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A PPO health insurance plan offers greater flexibility than HMOs. You are not required to select a primary care physician (PCP) and may seek treatment from any provider you wish. You may also go to any specialist without referral. However, the overall cost of a PPO health insurance plan is higher than an HMO health insurance plan. You have to pay a percentage of each medical visit (called co-pay) and satisfy a deductible before benefits are paid. The percentage of reimbursement depends on the type of policy and whether the doctor/hospital is within the PPO network. If you use a physician, hospital or healthcare provider outside of the PPO health insurance network, your out-of-pocket expense will be more. You may also have to pay the entire bill yourself, and then submit it for reimbursement. |
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A POS health insurance plan is a hybrid of PPO and HMO. Like an HMO health insurance plan, you must select a PCP. However, you may choose to visit a physician outside the network without permission from your PCP and still receive coverage – but your share of the bill will be higher. Monthly premiums of POS health insurance plans are usually higher than HMOs. However, it gives you the flexibility to seek treatment from both in-network and out-of-network providers.
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