The types of Insurance Plans; HMO, PPO, EPO & POS

It's open enrollment for my family's health plan so I thought this would be an appropriate time to go over each plan type. It can be confusing, you get one chance each year to choose a plan that's going to fit your family's needs along with fitting the needs of your budget. Let's go over the basics;

HMO - These are usually the most affordable type of plans, but also comes with some boundaries. You'll have to select a PCP (Primary Care Physician) and you can only see providers that are In Network. Typically the only time Out of Network care will be covered is in the event of an emergency. If you need to see a specialist your PCP will have to write a referral for you, but will help coordinate your care with that specialist.

PPO - These are the most flexible plans, but come with a price tag. With PPO plans you aren't required to select a PCP so you don't have to wait for a referral to see a specialist. Also, most PPOs have Out of Network benefits. Meaning you can see a provider that is Out of Network but co-pays, deductibles may be more expensive than a provider that's In Network. If you have health issues, or know you will need extended health care in the near future then PPO plans are a great option if it works for your budget!

EPO - Similar to PPOs EPO plans do not require you to select a PCP, so seeing a specialist is easier without the need for a referral. But like an HMO you have to see providers that are within your own Network, which tend to be larger than HMO networks. EPOs are a great plan if it's an option for you; it has the flexibility to see a specialist when you feel it's necessary as long as you don't mind staying within your Network, but comes with lower premiums than PPOs because of that restriction.

POS - POS plans do require you to select a PCP so you will need a referral in order to see a specialist. However, unlike the above mentioned EPO plans POS plans typically come with some Out of Network coverage as long as you have that referral. POS plans are a great alternative option to HMOs because they give you a little more flexibility but aren't as costly as PPOs. They come with a slightly higher premium since you are not restricted to your Network but it is imperative to get that referral first so you are not stuck footing the bill.

Health insurance is important and almost all plans come with some type of restriction. Make sure you are reading over your options carefully, ask your HR or Benefits Coordinator questions, or hop on the phone and speak to the insurance directly! This is a decision you should feel informed making and not taking a guess at!