The Many Forms of Managed Care

HMO, PPO, POS—it’s a veritable alphabet soup of health plans! Choosing the right insurance first requires understanding what features each type has to offer and which ones will meet your personal and financial needs.

The Many Forms of Managed Care
The Many Forms of Managed Care

Three Basic Types of Managed Care:

  • Preferred Provider Organization (PPO): The main concept behind a PPO is the network. If you utilize this type of health insurance, you may choose any health care provider from within your network, determined by your policy, or any non-network health care provider. You usually are required to make a co-payment or pay co-insurance. Staying in-network saves you a bundle with PPO!
  • Health Maintenance Organization (HMO): Like the PPO, the HMO requires you to make a co-payment to an in-network physician. However, the HMO will not pay for services you receive outside the network. In order to obtain specialty care, you must attain a referral to a specialist from your primary-care physician.
  • Point of Service (POS or Open Access HMO)This health insurance plan is similar to the HMO. However, when you need care, you can go out of network. But the POS will reimburse you only 50 to 80 percent and you also may be required to pay co-insurance and a deductible.

You May Want a PPO If:

  • You’d like the option of seeking out-of-network care
  • You don’t mind making a co-payment—usually about $20—at the time of each visit
  • You don’t mind paying a yearly out-of-pocket deductible before your insurer will begin coverage
  • You’d like to benefit from discounted prescriptions and a large network of doctors from which to choose

You May Want an HMO If:

  • You are a relatively healthy individual with no abnormal conditions that would require a specialist
  • You want to avoid filling out numerous insurance forms
  • You value preventative health care in the form of programs that encourage healthier life choices to achieve better health
  • You’d like to benefit from slightly reduced premiums
  • You don’t mind working with only one primary-care physician who must refer you to a specialist for any unusual medical needs

You May Want a POS If:

  • You can’t decide between a HMO and PPO—this one is like a hybrid of the two
  • You’d like to choose between the HMO or PPO option each time you need care
  • You’d like the flexibility of going out of network and don’t mind higher co-pays or coinsurance when you do
  • You’d like to decide whether or not to pick a primary-care physician

Evaluate your health, financial situation and time constraints—even your personality type. If you are the type who prefers structure and organization, an HMO may suit you better than a PPO. If you have a chronic health condition that requires frequent medical attention, a PPO or POS may be your best bet.

Weigh the options, talk to friends and family about the types of plans they have, and choose what you think will work best for you!

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