HMOs PPOs or POS plans in medical health care ?
Name some major differences and similarities between health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point of service plans (POS)? Which product would you prefer?
HMO’s may cost less out of pocket, but you have less options when choosing physicians/providers. You have to select a PCP (primary care physician) often without knowing much about them, to coordinate your care. Referrals from the PCP are required to recieve benefits when you see specialists. No referral means no benefits. Also, you have to stay in the network of providers, otherwise there is no coverage. All procedures also have to be pre-approved most of the time, so sometimes there is more waiting involved.
A PPO often involves more out of pocket expense, but there are more options when choosing providers. There is also lower coverage when you choose an out of nerwork physician. You are able to choose your doctor, there is no requirement for a PCP, and you can see a specialist when you choose. These types of plans can have HMO-like copays, but most of the time you will be required to pay a deductible before the insurance company pays any portion of the bill. Once the deductible has been met, you will likely have to pay a percentage of the total bill. For examble, you will have to pay 10% while the Plan pays 90%. This is known as co-insurance.
A point of service plan is a combination of both the HMO and the PPO. You have to have a primary care physician cooridinate your care, but there is a better selection of providers than in an HMO. POS plans often involve copays instead of deductibles and co-insurance. There are out of network benefits, however they are signifigantly lower, which means that more money will be paid out of pocket.These plans often have better coverage for various procedures and hospitalizations. However, the premiums (amount you pay per month) are often much higher than the two previously mentioned plans. I was enrolled in a similar plan in 2001 and the plan paid 100% for many things such as the knee surgery, multiple braces and crutches, and orthotics that I had to have. You dont see this as much anymore!
I prefer the point of service plans because of the better coverage and lower co-payments. I also like having a better choice of providers.
I am currently enrolled in an HMO plan, and while there are things I don’t like about it, I don’t have medical bills piling up whenever I need a procedure or surgery done.
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