Question

In your own words, describe and compare the following( one paragraph each)

1. Preferred provider organization

2 point of service plans

3 HMOS

Answer 1

It is a type of health plan which has a contract with medical providers, such as hospitals and doctors, to create a network of participating provider organization, which is also known as PPO. In this plan you pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the in network at an additional cost.

In health insurance this is considered as a preferred provider organization, which is referred to as a participating provider that is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third party.

This is one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit which ever network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

Now the Point Of Service plan, which is also known as POS, is a type of managed care health insurance plan that provides different benefits depending on whether the policyholder uses in network or out of network health care providers. A POS combines the features of the two most common types of health insurance plans, the Health Maintenance Organization, known as HMO and the Preferred Provider Organization which is referred as PPO. POS plans only represent a small share of the health insurance market, but most policyholders have either HMO or PPO 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.

A point of service plan is like an HMO where it requires the policyholder to choose an in network primary care doctor and to get referrals from the doctor if they want the plan to cover a specialist’s services. And a point of service plan is like a PPO in that it still provides coverage for out of network services, but the policyholder will have to pay more than, if they used in network services. However, the POS plan will pay more toward an out of network service if it is referred by the primary care physician than if the policyholder goes outside the network without a referral. The premiums for a POS plan fall in between the lower premiums offered by an HMO and the higher premiums of a PPO.

A health maintenance organization referred to as HMO is an organization that provides health coverage on a monthly or annual fee basis. A Health Maintenance Organization known as HMO, is a group of medical insurance providers that limit coverage to medical aid provided from doctors that are under the contract of HMO.

An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO's network.

HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.

Now speaking about the difference between HMO and PPO plans includes the size of the plan network, ability to see specialists, plan costs, and coverage for out of network services.