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When shopping for health insurance there are many things to consider for your options. There are a couple of plan styles to choose from in the healthcare marketplace, lets look at them.
HMO: Health Maintenance Organizations (HMOs) are legally organized entities that share the common characteristics of responsibility for both financing and delivering comprehensive health care services to a defined group of members for a prepaid, fixed fee. HMOs differ from traditional insurance indemnity plans in that they are both the financing and servicing mechanism. They emphasize preventative medicine and early treatment through prepaid routine physical examinations and diagnostic screening techniques. At the same time they, provide complete hospital and medical care for sickness and injury.
PPO: Preferred Provider Organizations (PPOs) are groups of health care providers that contract with employers, insurance companies, union trust funds, or others to provide medical care services at a reduced, negotiated fee. Like HMOs, they make take the form of group practices or separate individual practices. PPOs typically differ from HMOs in two aspects. First, they provide benefits on a fee-for-service basis as their services are used. Fees are usually subject to a schedule that is the same for all participants in the PPO. Second, plan participants have financial incentives to use the preferred provider network. A participant’s access to specialist is not controlled by a primary care physician, as is the case in HMO plans.
EPO: Exclusive Provider Organizations (EPOs) are similar to PPOs in their organization and purpose, but unlike PPOs, EPOs limit their participants to participating providers. In general, individuals covered by an EPO are required to receive all their covered health care services from providers that participate with the EPO. Because of the severe restriction on choice of provider.
POS: Point-of-Service-Plans (POS) are not really a health care provider per se; however they are more of a hybrid arrangement that combines aspects of traditional medical expense plan with an HMO or PPO. In a POS plan, a participant’s access to a provider network is controlled by a primary care physician. Participants retain the option to seek care outside the network but at reduced coverage levels. POS plans are sometimes referred to as open ended HMOs. The POS plan is the fastest growing health plan in the United States.
PHO: Physician-Hospital-Organizations (PHOs) are organizations that are jointly owned and operated by hospitals and their affiliated physicians and typically are developed to provide a vehicle for hospitals and physicians to contract together with other managed care organizations to provide healthcare services. Carve-out-plans are health care programs managed separately from an employer’s general health care plan by HMOs or PPOs that specialize in a particular type of care. An HMO or PPO that specializes in a particular type of care may be more successful at controlling cost for that type of care than a general purpose medical care network. Mental health, substance abuse, prescription drugs, and dental care are some of the more common types of care approached in this manner.
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Source by Carlos Diez
