Health plans  HMO – PPO – POS – EPO – HDHP;  what’s the difference?

HMO; Health Maintenance Organization.  HMOs restrict the choice of providers  and limits service areas to your county of residence.  HMOs also use capitation whereby the insurance company pays your provider a monthly fee even if you don’t see your provider.  No need to submit claim forms.  Referrals are done through your “primary care physician”.

PPO: Preferred Provider Organization.  Has a broad choice of providers and much wider coverage territory.  Cost of services are pre-negotiated with the preferred providers.  Also allows use of providers outside of the insurance company’s listed network but then requires more expense out of your pocket.  Allows you to go to specialists without a referral.  You may need to handle claim forms.   These often have higher deductibles and coinsurance.

EPO; Exclusive Provider Organization.  Nearly the same as a PPO, but does not allow use of providers outside of their network.  Yet its not an HMO since you can usually go to other providers without a referral.

POS:  Point of Service.  A combination of HMO and PPO depending on which provider you go to at the time you seek services – its your choice.  If you go to an HMO office you will get HMO style of benefits.  If you choose a PPO office you will get PPO benefits and usually have to meet a higher deductible or copayment. You must still use the provider network.

HDHP:  High Deductible Health Plan.  High deductibles have to be met for most services.  Deductibles usually start at a minimum of $1000.  Premium costs are usually on the low side.  These plans are given preferred tax treatment by the U.S. Gov’t and must meet USG requirements.   If you want to use an HSA account, you must have an HDHP plan to go with it.  These plans can be HMO or PPO.