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Health Insurance 101
Let’s start with the basics. Today, most Health insurance plans are categorized in HMO, POS, PPO and Open Access.
The differences:
HMO – Health Maitanence Organization: You choose a primary care doctor in their network. Your care will be managed by that doctor, local medical groups and hospitals. Your doctor will make most decisions on your care and may refer your out to specialist for care they cannot give. The benefits for an HMO tend to be very rich. You are usually just paying copays for office visits, prescriptions and hospital stays. |
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PPO – Preferred Provider Organization: Offers a lot more flexibility, then an HMO. There still are network of doctors / hospitals that you can choose from, however you do have the freedom to seek doctors / hospitals that do not participate with the insurance carrier, which is commonly referred to as Out of network Benefits (OON). There are usually deductibles (an amount you pay before insurance carrier pays) and CoInsurance (a percentage you pay up to a maximum) for OON services. You do not need to choose a primary care or get referrals to see specialists.
POS – Point of Service: This option is the “in between” option. In – network, it’s very much like an HMO. You choose a primary care, you get referrals for specialists, etc.
However it does offer an Out of Network option like a PPO.
O/A – Open Access: Certain carriers offer O/A options to be added to their HMO or POS. With this option added, it allows you to Self Refer to see a specialist In – Network. Adding this option typically increases the premium by 5%.
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