Basic Types of Managed Care – HMO, PPO, POS

Posted in Group Health Insurance , Health Insurance

March 17th, 2009

When it comes to health care in the United States, managed care insurance programs are the preference for the vast majority of people with health insurance. People over 65 might qualify for Medicare, and people making less than a certain amount of money could qualify for Medicaid, but by and large, the biggest players in the health insurance game are managed care programs. Of the managed care programs, three of the most basic and best known are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (POS).

Health Maintenance Organizations

HMOs are one of the biggest kinds of managed care insurance providers in the country. They keep costs down by dealing in large groups of people, which lowers the fees charged by the doctors and medical facilities that contract with them. Additionally, HMOs focus on preventive care, also to keep costs down, and they restrict the procedures that doctors can perform.

Preferred Provider Organizations

PPOs offer their members more flexibility, and they cost more money. With a PPO, you can go to any doctor or medical facility in their network. You can also go outside the network if you want, but the PPO won’t cover as much of the visit or procedure if you do so. In fact, the PPO may not cover any of the procedure, especially if it is extremely expensive, or they don’t cover it in their network in the first place.

Point of Service Plan

A point-of-service plan is considered by many managed care insurance experts to be a hybrid of HMOs and PPOs. POS plans also deal in doctor and medical facility networks, but you are allowed to go outside the network if your primary physician authorizes it. If you don’t get authorization from your primary care physician, your POS managed care insurance plan might very well not pay for it.

To learn more about HMOs, PPOs and POS plans, as well as other aspects of managed health care plans, be sure to consult with a health insurance expert.