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HMO, POS, or PPO

Health insurance is a contract between an insurance company and an individual that helps manage the costs of doctors’ visits, emergency care and routine tests. There are three main types of health insurance; Health Maintenance Organizations (HMO), Point-of-Service (POS) and Preferred Provider Organizations (PPO). YourFreeQuotes.com helps explain the differences in these plans.


An HMO is a prepaid health plan. You pay a monthly premium as a member. In exchange, the HMO provides care for you and your family, including doctors' visits, hospital stays, emergency care, and other services. You will usually be responsible for a co-payment at the time of each visit. Upon enrollment, you choose or are assigned to one doctor to serve as your primary care physician (PCP). This is the doctor you see on a regular basis; he/she will refer you to specialists and other health care providers as they see necessary. Visits to specialists without authorization from your PCP are rarely covered. Typically, your choices of physicians and hospitals are limited to those that are under contract (or in-network) with the HMO to provide care. Exceptions may be made in emergencies or when medically necessary. Also, an HMO provides preventive care, such as yearly exams, immunizations, and screenings. Services covered vary from plan to plan so it is important to compare health insurance before.


POS plans are fee-for-service plans. The primary care doctors in a POS plan usually make referrals to other providers in the plan. Members in a POS plan can also refer themselves outside the plan and still get some coverage. If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have an out-of-pocket expense.


A PPO plan is similar to an HMO in that there are a limited number of doctors and hospitals to choose from. When you use those providers, most of your medical bills are covered with the exception of a small co-payment. PPO plans also provide preventive care in the form of annual physicals, health screenings and immunizations.


A big difference between PPO and HMO is that you can use doctors who are not part of the plan and still receive some coverage. You may be responsible for a larger out-of-pocket expense and be required to submit reimbursement forms. This is a great option for many people because they do not have to select a new physician.


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