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HMO… PPO… POS… What’s the difference?

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texas health insurance plansWhen shopping for Texas health insurance, it’s important to know the differences between the types of available plans.  Most Texas health insurance plans can be categorized as either indemnity plans or managed care plans. Managed care plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point of service (POS) plans.

Indemnity plans have the greatest flexibility, allowing you to choose your own doctors and the amount your insurance will pay toward your medical expenses. Managed care plans are plans based upon an agreement made between Texas health insurance companies and specific health care providers; this usually results in discounted rates for consumers.

Health Maintenance Organizations (HMOs)

HMO plans generally require individuals to select a primary care physician from a list of qualified health care providers partnered with the HMO. The primary care physician refers patients to any other needed health care providers, ultimately acting as the coordinator for all of a patient’s medical care. In the event of an emergency, a referral is not required, but if an “unapproved” provider is visited, the individual will incur most, if not all, of the costs of the services received.

When considering an HMO, one must check the list of accepted providers. If you are pleased with the providers available, then an HMO might be the best option for you.  HMOs require a co-payment for each doctor visit, but they are the least expensive health care option, as they do not require a deductible to be met. As long as you use the services of the selected providers and get a referral from your primary physician when visiting specialists, an HMO is an affordable Texas health insurance option to consider.

Preferred Provider Organizations (PPOs)

PPOs are similar to HMOs, but they are a bit more flexible, especially in terms of provider options. PPOs usually provide some coverage for out-of-network providers, do not require referrals, and do not require you to select one primary care physician. Because of the increased flexibility with these plans, co-insurance is applicable in situations when out-of-network health care services are used, due to the absence of pre-negotiated discount agreements.

Point of Service Plans (POS)

A combination of elements found in PPO and HMO plans can be seen in POS plans. For example, as with HMOs, POS plans require people to choose one primary care physician and require referrals from this physician in order to visit specialists. However, like PPO plans, you are able to visit out-of-network physicians, and if your primary care physician refers you to this provider, your POS plan will pay most or all of the costs. This may be the best option for individuals looking for Texas health insurance who live and work in multiples cities, where flexibility in the choice of doctors and hospitals is of great importance.

Understanding the differences between Texas health insurance plans will assist you in your quest to obtain the most affordable health care. If you have further questions or are still confused about which option is best for you, consider contacting the local Texas health insurance experts at Custom Health Plans.

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