What is the difference between an HMO, POS, or PPO?

You may hear many different types of health insurance plans thrown around, so how do you know which one is the best for you to choose? Contact Taake Insurance Agency, serving Columbia, IL, for help as you navigate.

What is an “HMO?”

HMO stands for “Health Maintenance Organization.” The goal of an HMO is to focus on keeping individuals healthy and introducing structure to outpatient care. Your main point of contact for your care will be a primary care physician or PCP. If you need specialty care, your PCP will refer you to a specialist within the care network for further treatment. A referral is required to schedule.

What does in-network mean? HMOs function as part of a provider network of affiliated organizations. This helps HMOs keep costs lower, and HMOs typically offer the lowest out-of-pocket costs as a result.

HMOs generally do not pay for out-of-network care except in the case of emergencies.

What is a “POS?”

POS stands for “Point of Service.” Like an HMO, a POS will manage care through your PCP. Unlike an HMO, you will not need your physician’s permission to visit other doctors in or out-of-network.

In this model, the average costs are higher out-of-pocket than for an HMO. Receiving care out-of-network will cost more out-of-pocket.

What is a “PPO?”

PPO stands for “Participating Provider Option.” A PPO generally offers the most flexibility but at a higher out-of-pocket cost. With a PPO, you will not need to choose a regular doctor or get referrals to receive specialty care. If you need or choose to go out-of-network, a PPO will pay a portion of out-of-network costs.

Contact Taake Insurance Agency, serving Columbia, IL, for your questions and to get a quote.