When shopping for a health insurance plan for you and your family, the cost isn't the only thing to consider. Not only do different types of plans determine the amount of out-of-pocket expenses you pay, different plan types determine from what doctors, hospitals, and other healthcare professionals you can receive medical services. Different types of health plans also offer different levels of benefits.
HMOs, or Health Maintenance Organization plans, require that you stay in-network for the plan to cover your medical expenses. Although HMOs offer lower out-of-pocket costs, you need a referral from your primary care provider (PCP) to see a specialist or schedule a diagnostic test or procedure. If you find that it's easier to let someone else handle your health care issues, your PCP is responsible for coordinating the services you need.
But despite the lower cost to you, an HMO may not be the better plan choice if you live in a rural area where there are no local in-network doctors, or the choices within the plan's network are limited. Not all HMO plans offer large networks with primary care doctors or specialists within your service area.
PPOs, or Preferred Provider Organization plans, allow you to see any doctor or specialist within the plan's network. A PPO plan doesn't require a primary care physician, and you can go to providers outside of the plan without a referral, but it will cost you more in out-of-pocket expenses.
However, if you want to choose your own doctor, a PPO may be the better plan type for you. A PPO also may be the better choice if you live in a rural area where you have limited access to doctors and hospitals within your geographic area.
While POS, or Point of Service (POS) plans, allow you to go to doctors and hospitals that do not participate in the plan's network, receiving medical care from in-network providers lowers your out-of-pocket expenses. The premiums you pay for a POS plan are generally less than those for a PPO, but more than the monthly premiums for an HMO plan.
Although a POS plan allows you to go to out-of-network providers, you still need a referral from your primary care provider. If you choose out-of-network care, you must meet your annual deductible and pay a percentage of both the doctor's fee and costs for any other medical services you receive.
EPOs, or Exclusive Provider Organization plans, require that you use in-network providers unless you need emergency medical care. An EPO can cost you less than an HMO or PPO, and you don't need a primary care doctor or referral to see a specialist. Although the doctors and medical facilities that participate in EPO plans offer health insurance companies discounted rates, there may be a limited number of providers in your network area.
Additional Factors to Consider
A health plan's out-of-pocket costs may include annual deductibles, copayments, and coinsurance. Therefore, keep in mind that if you select a plan with lower premiums, you will pay higher out-of-pocket costs. However, depending on your medical needs and those of your family, a plan with higher monthly premiums that pay more of your medical costs is often the better choice.
This may be the case if you or a dependent covered by the plan has a chronic medical condition, sees specialists often, or needs regular medical treatment and ongoing prescription medications. But if you and your family members are in fairly good health and see a doctor only occasionally, a plan with lower monthly premiums, but higher out-of-pocket costs may be a practical-and cost-saving-choice for you in the long run.
The benefits a health plan offers is another important consideration. Health plans vary in the scope of benefits they offer; therefore, compare plans and then choose a plan that offers the maximum of the services you and your family need most.If you need help choosing the right health insurance plan, the staff of S.N. Anthony Insurance Inc. is here to answer your questions.