Customer often ask about the different types of plans and how they work, Insurance is important but not always interesting to those who need it. they just want someone to simply explain the differences.
Simple Synopsis of Managed Health Plans or Network Plans
Health Maintenance Organizations pre-arrange for reduced health care expense through a network of physicians who have agreed to work within the organization at discounted fees. The HMO usually requires you to select a primary care physician from within the network. The idea is to use the network to both reduce healthcare cost and better manage what treatments are sought out by the patient by using a primary care physician as a gatekeeper. The benefit carries on to the consumer with lower premium cost.
A preferred provider organization (PPO) is another form of managed care, yet more closely similar to the indemnity type plans in that you have the option to select your own physician either from the network or outside of the network with the difference being that the cost of service is usually lower inside the network. Like the HMO a PPO negotiates price discounts for service with the physicians and care facilities, who become members of the PPO which passes on the savings to consumers in the form of premiums. Many consumers like the idea of having the ability to choose a specialist from the PPO network without having to see the primary care physician first for the referral.
A Point of Service or POS is also a managed plan but differs in that you are required to allow your primary care physician to act as an initial starting point for all medical service. The primary care physician is chosen by the insured from within the network and referrals and usually that specialist from within the network.