You’ve probably come across at least one of these names before HMO, PPO, EPO, POS, and you probably tuned out immediately. We don’t blame you, it can get tedious, but it’s important to learn about it because it could save you some serious money. HMO, PPO, EPO, and POS are abbreviations for the plan types available in the individual health insurance marketplace. Each plan type is separated by network and coverage options, which means which doctors you can see and how much you’ll pay.
HMO (Health Maintenance Organization)
HMOs are super common. If you have an HMO, your insurance coverage is usually limited to care from a network of providers working for or contracting with your insurance company. Basically meaning: If you get care in the network, you’re covered. If you go to someone outside the network, you’re not. Also, if you want to see a specialist, you may need a referral from your primary care doctor.
PPO (Preferred Provider Organization)
With PPO plans, you typically pay more, but you’re getting more choices because you have the option to see doctors outside of the network. PPO plans require higher cost-sharing or copays when seeing doctors outside their network of preferred doctors. Still, you usually pay less if you use providers in the network because they have negotiated lower rates with your insurance company. Referrals are not required to see a specialist.
EPO (Exclusive Provider Organization)
With an EPO, you’re monthly costs will typically be lower, and there’s no referrals. You’re covered when you see a doctor in the network, and you get care with doctors outside the network, it won’t be covered except in certain situations (like emergencies or if there are no in-network options available). Referrals aren’t required to see a specialist, so when you find an in-network specialist you like, there’s no need to get permission from a primary care doctor. It makes things a whole lot faster!
POS (Point of Service)
POS plans are less common plans. With a POS, your coverage works like a hybrid of an HMO and PPO plan. It provides lower costs for care when you use in-network doctors and includes coverage for out-of-network care with a referral. POS plans require that you select a primary care doctor and obtain a referral to get care with a specialist, even if they’re in-network. If you do use a doctor outside of the network, you’ll need to take care of the insurance paperwork yourself.
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.