What do PPOs, HMOs, and POS plans have in common? They are all
forms of managed health plans, and you need to be familiar with
them when you shop for health insurance. PPO means preferred
provider organization; HMO means health maintanence
organization, and POS means point of service.
In general, managed care plans provide their members with health
care from within a network of providers. In other words, members
can only go to certain doctors and hospitals that belong to or
agree to participate with a particular network. Managed care
plans also take care of claims processing that result from a
medical service.
A health maintenance organization generally provides the least
expensive medical care. HMOs offer medical services in exchange
for a fixed monthly premium. However, HMO clients have no
freedom to choose their own doctors and hospitals and can only
use providers in the HMO network. Doctors belonging to a
particular HMO normally refer patients to other HMO doctor
members, and a referral from an HMO primary care doctor is
needed in order to see a specialist.
A preferred provider organization, or PPO, allows its members
greater lattitude in choosing which doctors they can see.
Physicians within a PPO make referrals, but the members can
refer themselves to doctors and specialists including those
outside of the plan. However,though members have the freedom to
go outside of the PPO and will still receive coverage, they will
pay more for seeing providers out side of the PPO network.
In a point of service plan (POS), Primary care doctors refer
members to other doctors, usually within the plan, but members
can refer themselves outside of the plan, though they will pay
more. If POS doctors refer a patient outside of the plan, the
POS usually pays most of the fee. Participants in these plans
choose their own doctors and hospitals, and can refer themselves
to whatever doctor or specialist they choose.
It is also important to understand fee-for-service, or FFS,
plans. These are not really managed care plans in the sense that
there is a pre-existing network of providers in place. Fee For
Service plans are often much more expensive in comparison to
HMOs and PPOs. However, FFS plans allow participants greater
lattitude in who they can see. FFS beneficiaries can choose what
doctors, and specialists they prefer to see and what hospitals
they can go to. In an FFS, what determines what provider members
use is whether or not the provider accepts the insurance.
Normally, FFS plans require much more in out-of-pocket expenses
and require members to pay in full up front and then file for
reimbursement.
The plan you ultimately choose will depend on personal needs,
whether or not you are single, married, married with children,
whether or not the insurance is available in your geographical
area, and of course, the amount of income available for health
insurance. One very important point to remember is that health
insurance, as all insurance, is protection. The better you
understand the kind of protection you need, the better your
choice will suit your needs.
About the author:
Evan Davis works in Medicare customer service and is the owner
and webmaster of Instant Health Insurance. Find
cheap health
insurance quotes online and
low cost
health insurance at
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www.find-health-insurance-online.com
