Four Basic Types of Health Insurance Plans

Choosing health insurance requires making an informed decision. HMOs, PPOs, EPOs, and POS plans are common categories. Most health insurers require that you share in paying your medical costs through copays, deductibles, coinsurance or all of these.

Health Maintenance Organizations mandate that you use a physician, hospital or healthcare facility that’s in their provider network. Otherwise, they will pay a portion of your out-of-network medical bills only in an emergency. HMO’s require that you select a PCP to coordinate your care with other healthcare providers. To see a specialist, you must get a referral from your primary care physician. Of all the plans mentioned here, this one usually has the lowest monthly premium.  

With Preferred Provider Organizations, you don’t need referrals, and you don’t need to choose a PCP. Select from a large number of hospitals and physicians as well as out-of-network providers (at a higher cost) who do not need to be local. The monthly premium for PPOs is higher than for HMOs.

Exclusive Provider Organizations restrict service to in-network providers. If you get emergency treatment out of the network, you’ll have to pay the bill, and then request reimbursement from your insurer. Depending on the terms of your coverage, you may or may not have to choose a PCP. You don’t need referrals.  

Point-of-Service plans have fewer physicians and hospitals to choose from than PPOs. However, the costs for using in-network physicians is relatively low and comparable to those for an HMO. You’ll need a referral to see a specialist, and seeing a provider outside the network will cost more and mean paperwork. 

At Silverton Insurance Specialist LLC, we can guide you in selecting the coverage that fits your health needs, lifestyle and stage in life.