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Healthcare Plan Options

Choosing a healthcare plan requires research to determine which type of plan option is best suited for your healthcare needs. There are three basic types of healthcare plans and although some may vary depending on your insurance, for the most part each option has some distinct attributes. Knowing more about the different healthcare plan options will help you decide which is best for you.

  1. Health Maintenance Organization (HMO)

    • Under a Health Maintenance Organization or HMO option, healthcare providers are contracted for their services. Approved health care providers form what is called the provider network. If you are covered by an HMO plan, you will only be able to see doctors who are in the network unless it is specially authorized by your insurance company. HMOs require you to select a primary care physician who will refer you to specialists when necessary. For example, if you have a skin ailment, you will not be able to just go to a dermatologist without first obtaining a referral from your primary care physician. HMOs are typically the most limiting healthcare option but also the least expensive.

    Preferred Provider Organization (PPO)

    • The primary difference between an HMO and a Preferred Provider Organization, or PPO, is that a PPO doesn't require the approval of a primary care physician to see a specialist. A PPO does require you to use doctors, physicians and specialists from within a contracted provider network, but they are usually much less restrictive than HMO options---allowing you to see doctors outside of the provider network at an increased cost. PPO plans are generally more expensive than HMOs although the freedom to choose your healthcare providers may be worth the additional cost.

    Point-of-Service Plan (POS)

    • Point-of-Service or POS healthcare plans combine aspects of both HMO and PPO plan options. In addition to offering a contracted provider network, POS plans also require you to choose a primary care provider who will refer you to specialists or other care providers when necessary. Unlike an HMO, you will not be denied coverage if you choose someone other than who your primary care provider referred. You may pay higher co-payments, but under POS plans you can still choose your own specialists from within the provider network.

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