It can be difficult to choose from the number of different health insurance plans that are available on the market today. Health insurance can have a significant impact on not only your health, but on your wallet so it is important to research the types of plans that are available, and to seek independent, financial advice if you feel that you need it.
In general, there are four main types of healthcare plan and all differ slightly in the cover that they offer. These plans are HMO, PPO, EPO and POS plans and choosing one is very much down to individual preference. Basically, the plans differ with regard to coverage limitations and access to different networks of service providers.
HMO (Health Maintenance Organization) plans are very popular. If you become ill then you will need to initially visit a primary care physician who will assess your condition and refer you, if necessary, to a specialist. The plan stipulates that you must consult with health care specialists within a specific network of hospitals and physicians. If you wish to see a doctor who is not contracted by the health insurance provider you must do so at your own expense, unless it is an emergency.
An HMO could be the ideal choice for you if you prefer to visit an individual physician with regard to all aspects of your health. Apart from having to choose from the providers stipulated by the insurance company there are few other limitations, and the plan is less costly than some others.
PFO (Preferred Provider Organization) plans provide more flexibility with regard to your choice of specialists and physicians. This choice is not limited to healthcare providers within the network, but if you do choose a provider outside of the prescribed network you may have to pay more until you reach your plan’s deductible. With this type of plan you can access a specialist straightaway without having to see a primary care physician first so it could be a good choice for someone who needs access to a number of different specialists.
EPO (Exclusive Provider Organization) plans are similar to HMO plans in such that they require you to keep within a limited network of providers, but they do not stipulate that you are seen first by a primary care physician. EPOs are quite strict with regard to you staying within their chosen provider network; even in emergencies they may ask that you pay some, or all of the expenses incurred.
An EPO plan would probably suit you if you wish to keep your health insurance costs to a minimum and wish to avoid waiting for referrals to see specialists, especially if you don’t mind researching the prescribed specialists and providers within a specific network.
POS (Point of Service Plans) work differently to other health insurance plans available in that they offer you the option of seeking care outside of the prescribed network. However, if you do wish to do this you will need a referral from a primary care physician. POS plans vary in that some will cover all out-of-network charges whilst others will only pay some of the fees incurred. In common with HMO plans if you are not referred by a physician then you will in all likelihood have to pay the costs yourself, except in cases of emergency.
If continuity of care is a concern and you prefer to liaise with the same primary care physician then a POS plan could be ideally suited to you.
In general, those insurance companies who insist that you visit an in-network doctor will offer cheaper premiums as health insurance providers secure lower rates with those physicians and hospitals who are contracted to their network. By venturing outside of these networks you are likely to pay more.
To summarise, POS and HMO plans might be the best option for you if you don’t mind seeing a specialist that your primary care physician chooses for you. These types of plans also take the legwork out of looking for a suitable specialist; visits can be planned on your behalf by your doctor’s staff. However, if you prefer to find a specialist yourself then a PPO or EPO plan could be a better choice. A PPO is probably best if you live in a rural, more remote area which gives you limited access to care providers as your location may mean that you are forced to go out of your network. Similarly, an EPO is probably a good choice if you live in a larger, more highly populated area, and will help to keep your costs as low as possible.
Choosing the right type of health insurance plan is a big decision and it’s important to weigh up the pros and cons of each one in order to secure the best plan for both you and your family. If you are changing your plan but want to keep your current physician be sure to check that your doctor’s office is happy to accept the new plan or you could incur significantly higher costs. If your physician is not able to work within the confines of your new plan then a PPO plan is possibly the best option as it will cover your out-of-network charges.
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