What is a PPO HMO POS EPO

Is it an acronym city or the abbreviations you put behind your name! Health insurance plans are categorized by a few main ways: PPO, HMO, POS, and EPO.

Depending on which plan you buy, depends on if your care is covered when you see a network provider or any doctor. In addition, you may have larger deductible or coinsurance, and/or you may have to get a referral if you want to see a provider out of network

PPO (Preferred Provider Organizations)

PPOs give you the choice of seeing providers in network or out-of-network. You pay less if you use in network providers. You’ll pay more if you want to go out of network for doctors, providers, and hospitals. You may have higher out-of-pocket costs too. If you have a PPO plan, you can visit any doctor without a referral.

POS (Point-of-Service)

POS plans let you go to both in-network and out-of-network providers. With a POS plan, you will have to choose a PCP or primary care doctor from a list of participating providers in network. Your PCP will refer you to other in network providers as needed. If you choose to go to an out-of-network provider, you’ll need a referral and you may pay higher out-of-pocket costs.

HMO (Health Maintenance Organizations)

HMO plans usually require you to seek care from in network providers who work for or contract with the HMO. An HMO generally doesn’t cover or has limited coverage if you go out-of-network except in an emergency. If you choose to see a doctor or facility that isn’t in the HMO network, you may have to pay the full cost. Like the POS plans, HMO members usually have a PCP and must get a referral to see a specialist.

EPO (Exclusive Provider Organizations)

EPOs are much like the HMO in that they generally have coverage only if you see a provider in the EPO network (except in an emergency). Health plans generally can’t require higher copayments or coinsurance if you get emergency care from an out-of-network hospital, no matter what type of plan you have. However, providers may bill you for some additional costs.

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