Health insurance has a lot of different pieces, and one of the most significant pieces is the health insurance network types. Health insurance networks are groups of doctors and medical care providers who are under contract to treat customers under a provider's insurance plan. In these networks, terms like in-network and out-of-network doctors come into play. In most cases, in-network doctors or medical providers offer discounted prices. Additionally, insurance companies are more likely to cover their in-network doctor fees.
Finding a network that matches your medical and financial needs is essential. There are four main types of health insurance networks: the Exclusive Provider Organization, Point of Service, Health Maintenance Organization, and Preferred Provider Organization. These plans have different regulations regarding out-of-network care and the overall cost.
HMO: Health maintenance organization
A Health Maintenance Organization plan or HMO tends to require customers to stay in the network or they won't cover the costs. However, 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 best specialists.
PPO: Preferred provider organization
The Preferred Provider Organization is the most flexible regarding in and out-of-network care. Although they would prefer you use an in-network provider because it's cheaper, they will also help pay for out-of-network providers. On top of this, referrals to see specialists are often not required adding a level of freedom to whom you choose to see. However, with this flexibility and freedom comes a cost, with PPOs usually having higher premiums and higher out-of-pocket costs. Despite the higher prices, PPOs' flexibility has made them a favored plan.
EPO: Exclusive provider organization
The exclusive provider organization plan is one of the more restrictive plans as the insurance provider won't cover costs unless they are in-network providers. Despite having a restricted network, EPOs often do not require you to get a referral from a primary care provider before going to a specialist. As long as you stick with an in-network specialist, the option to see them is up to you. EPOs are known for having low cost-sharing reductions and low premiums. Despite this, EPOs also usually require pre-authorization. It is your responsibility to ensure that your treatment gets pre-authorized because your insurance company can refuse to pay if it doesn't. However, as long as you stay diligent, the freedom of no referrals and the low premiums can be enticing.
POS: Point of Service
The Point of Service 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 out-of-network, in most cases, the insurance will help cover the tab; however, if you choose to opt out of in-network, you must pay the bulk of the bill.
When picking a network plan that works the best for you, it's crucial to keep your current health status, finances, and health resources in mind. If you still aren't sure which plan suits your needs, Catch has Insurance Agents available and ready to help you.