Which health insurance plan is best - HMO, PPO, HDHP, POS, EPO? - PowerPoint PPT Presentation

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Which health insurance plan is best - HMO, PPO, HDHP, POS, EPO?

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The two most common health plans have been generally HMOs and PPOs, but HDHPs have become a lower-cost health insurance option for employers over the past decade. POS and EPO plans are options provided by some employers and health insurers, but they’re not nearly as common as HMOs, PPOs and HDHPs. Choosing the RIGHT Health Insurance Plan is Unique for Every Situation. The Independent Benefit Advisors, serving Raleigh & the Triangle, Charlotte, Wilmington and ALL of North Carolina can help determine the plan that is best for YOUR situation. For more info. Call at +1 (919) 303-9690 or Visit at – PowerPoint PPT presentation

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Title: Which health insurance plan is best - HMO, PPO, HDHP, POS, EPO?


1
What is the difference between HMO, PPO, HDHP,
POS, EPO?
2
  • When trying to determine which choice is the best
    for you, you need to take the following factors
    into account
  • How healthy are you and your family?
  • Does your health care provider accept only
    certain insurance providers?
  • Whats your current financial situation?
  • Do you want to pay more upfront in premiums or
    later in coinsurance?
  • Do you want flexibility in choosing your
    specialists?

3
  • The answer to these questions will make choosing
    an insurance option a little easier.
  • Preferred provider organizations (PPOs).
  • Health maintenance organizations (HMOs).
  • High deductible health plans (HDHPs).
  • Point of service plans (POS).
  • Exclusive provider organization plans (EPO).

4
What is an HMO? HMO stands for health
maintenance organization and makes up 16 percent
of health plans. It is known for its lower
premiums and restricted network of doctors and
hospitals, which means you sacrifice flexibility
for lower upfront costs. HMO PROS Lower
premiums Lower Cost Than a PPO HMO CONS Need
to stay in network Need referral to see a
specialist Youll likely pay less in premiums for
an HMO compared to a PPO sometimes
significantly less. Not all providers accept
HMOs, so before choosing an HMO, make sure your
provider or providers accept the plan. What kind
of person should choose an HMO Someone who wants
to pay as little as possible in premiums and not
have to face high deductibles. An HMO could be a
good option if you have a PCP and your other
health care providers are already in the HMO.
5
What is a PPO? PPO stands for preferred-provider
organization. Premiums and deductibles are
usually much higher for a PPO compared to an HMO,
but that comes with greater flexibility. PPO
Pros Larger Network, Can go out of network,
Dont need a referral for specialists PPO
Cons Higher premiums Has a deductible You
usually dont have to select a primary care
provider (PCP) in a PPO plan, and you can choose
from more healthcare providers than an HMO
because PPO networks are usually larger. PPOs
allow you to get both in-network and
out-of-network care though out-of-network
providers will cost you more. You can also see a
specialist without a referral. In addition to
higher premiums, PPOs usually have a deductible
that you have to meet before the health plan pays
for care. What kind of person should chose a PPO
plan Someone who utilizes health care regularly
and sees specialists or wants to have the option
to see a specialist without getting a referral.
6
What is an HDHP? HDHP stands for high-deductible
health plan. HDHPs have grown in popularity as
more employers have started to offer the plans as
a way to contain health care costs. HDHP
Pros Lower Premiums, Employer-contributed
HSAs HDHP Cons Need to stay in network, Need a
referral to see a specialist. Unlike the other
plans, an HDHP can vary depending on the specific
plan. For instance, one HDHP could be very
similar to an HMO, while another could look more
like a PPO. The critical piece of a HDHP is the
size of the deductible and Health Savings Account
that is attached to it. The deductible is
usually higher in an HDHP compared to other
plans. Youll want to keep that in mind if you
choose this plan, and you should set aside money
for the deductible in case you need it. What
kind of person should opt for a HDHP Someone who
is healthy and doesnt expect to use many health
care services within the next year. You want the
cheapest premiums and dont mind having to pay a
high deductible if you need a lot of care.
7
What is a POS? POS stands for point of service
plan and makes up only 6 percent of health plans.
POS plans are a hybrid of PPO and HMOs. In fact,
point of service means that the health care
consumer gets to choose whether to use HMO or PPO
services each time you see a provider. POS
Pros Dont need a referral, Can go out of
network for care POS Cons Need to file claims
if you go out of network, higher deductibles than
PPO and HMO POS plans usually have similar rules
to HMOs (for instance, you need to choose an
in-network physician as your PCP), but you can
see an out-of-network physician for a higher fee
in a POS plan. What kind of person should opt
for a POS Someone who likes being able to go out
of network for care, but also wants a PCP
coordinating your care.
8
What is an EPO? EPO stands for exclusive
provider organization and is a managed care plan
that requires you to go to doctors and hospitals
in the plans network. EPO Pros Dont need a
referral EPO Cons Need to stay in network for
care, limited network You dont need to choose a
PCP or need a referral, so in that sense, its
similar to a PPO, but you will only receive
coverage for providers in your network. Other
parts of an EPO plan are similar to an HMO, such
as having a limited network of doctors and
hospitals. You cant get care outside the network
unless its an emergency. Much like a PPO, you
need to get approval from your health plan in
order to get whats deemed as an expensive
service. What kind of person should opt for an
EPO Someone who doesnt mind having a limited
number of doctors and facilities and would rather
not have to get a referral to see a specialist.
9
Choosing The RIGHT Health Insurance Plan is
Unique For Every Situation. The Independent
Benefit Advisors, serving Raleigh The Triangle,
Charlotte, and ALL of North Carolina can help
determine the plan that is best
for YOUR situation.
10
Contact - Independent Benefit Advisors
Phone (919) 303-9690 Toll Free (888)
303-9690 Fax (919) 303-9691 Email
john_at_thebenefitadvisors.com Web
http//www.thebenefitadvisors.com
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