Health insurance networks are groups of doctors and medical care providers who are under contract to treat patients with a certain insurance plan.
If you're seeing a doctor, for example, who is part of the network your plan covers, then that coverage is considered in-network, which is generally cheaper than out of network care.
When picking a network plan that works the best for you, it's crucial to keep your current health, finances, and resources in mind. If you aren't sure which plan suits your needs, Catch Benefits Advisors are here to help. Schedule your free consultation today.
Which network type is right for me?
When it comes to different types of networks, it's an acronym salad. Here's a breakdown to clarify the differences.
There are four main types of health insurance networks: Health Maintenance Organization, Preferred Provider Organization, Exclusive Provider Organization, and Point of Service These plans have different regulations regarding out-of-network care and the overall cost.
HMO: Health Maintenance Organization
A HMO tends to require customers to stay in the network, or they won't cover the costs. Despite the stricter network, HMO plans boast a lower premium and less out-of-pocket costs for care and prescriptions. Furthermore, having an in-network primary care physician limits the number of claims you have to file. They can also help refer you to the in-network specialists.
PPO: Preferred Provider Organization
The PPO is the most flexible type regarding in and out-of-network care. Although they prefer that you use an in-network provider because it's cheaper, they will also help pay for out-of-network providers. Further, referrals to see specialists are generally not required, adding a level of freedom for whom you choose to see for care. However, with this flexibility and freedom comes a cost. PPOs usually having higher premiums and higher out-of-pocket costs. Despite the higher prices, PPOs' flexibility has made them a favored plan for many.
EPO: Exclusive Provider Organization
EPO plans is one of the more restrictive plans as the insurance provider won't cover costs unless they are in-network providers. Despite having a restrictive network, EPOs often do not require you to get a referral from a primary care provider before going to a specialist, provided the specialist is in-network. EPOs are known for having low cost-sharing reductions and low premiums. Despite this, EPOs also usually require pre-authorization for care. It is your responsibility to ensure that your treatment gets pre-authorized, because your insurance company can refuse to pay if it doesn't. If you stay diligent, the freedom of no referrals and the low premiums can be enticing.
POS: Point of Service
The POS plan allows for a little more flexibility with out-of-network care. However, it costs less to go to medical providers within the network. POS plans require a referral from a primary care provider to see specialists, whether in- or out-of-network. If the referral is in-network, in most cases, the insurance will help cover the tab. If you opt of out-of-network care, you'll likely need to pay the bulk of the bill.