If you have an HMO insurance plan, you have a select network of providers and facilities you can visit. Most HMO policies call for a primary care doctor who will manage your care. Many specialists require referrals so your primary care physician will serve as a point of contact between you and the specialists. This type of policy has monthly premiums as well as a deductible you must meet before your insurance will pay any claims. This deductible is paid through copays and other medical expenses. Typically, when the deductible is paid, your insurance will split the cost of any additional medical expenses with you. This is called a co-insurance and it’s talked about in percentages. For example, if your co-insurance is 80/20, it means that after you meet your deductible, your insurance will pay for 80% of your claim and you’ll be responsible for the remaining 20%.
With a PPO insurance plan, you have a bit more freedom in selecting your doctors. You aren’t required to get a referral from a PCP to see a specialist. The out-of-pocket costs and the amount of paperwork involved are higher if you go anywhere that is out-of-network. You still pay a monthly premium and you’ll still have to pay copays for any medical visits. Some PPO plans have a deductible and coinsurance but not all.
An EPO provides you with a bit more freedom to choose the providers you’d like to see. It’s also cost effective as you’ll pay less for an EPO than a PPO even when both policies come from the same insurer. As with a PPO, you aren’t required to get referrals to see specialists. However, unlike HMO’s and PPO’s, you have zero coverage with out of network providers. Unless it’s an emergency, any out-of-network costs will have to be paid completely by you. With this policy, you’ll still have monthly premiums, copays and coinsurances. Some have deductibles but not all.
A POS is a hybrid of an HMO and PPO plan. With this plan, you have some freedom to choose what providers to see. You’ll also have a primary care physician who will refer you to specialists. Costs are higher for seeing out-of-network providers. A POS plan is still subject to premiums, deductibles, coinsurances and copays. Your plan might require you to pay your deductible before it covers care beyond preventive services.
This insurance plan consists of higher out-of-pocket costs and low premiums. This policy allows you to enroll in an HSA (health savings account) to help cover the cost of your care. Other than preventive care, you must pay all costs up to your deductible relating to your medical care. However, you can use the money in your HSA to pay these costs.