When choosing your health insurance, you may notice words like “out-of-network,” “HMO,” or “Preferred Provider Organizations.” These words describe the different types of provider networks or plans. But what do they mean? Here’s a basic overview of what they are as described by healthcare.gov:
Provider Network: A provider network is a list of doctors, health care providers, and hospitals that a health insurance plan has contracted with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that hasn’t contracted with the plan is called an “out-of-network provider.”
The difference between the two basically boils down to how much you pay out-of-pocket for your visits. To see if your current providers (like doctors, psychologists, or physical therapists, and health care facilities like hospitals, urgent care clinics, or pharmacies) are covered under your plan, talk to your Unity Health Advisors agent.
Preferred Provider Organizations (PPOs): PPOs give you the choice of getting care from in-network or out-of-network providers. You pay less if you use providers in-network and you can visit any doctor without getting a referral.
Point-of-Service (POS): POS plans let you get medical care from both in-network and out-of-network providers. You can choose a participating primary doctor who can refer you to other network providers when needed.
Health Maintenance Organizations (HMOs): HMOs usually limit coverage to care from providers with its contractors. An HMO generally won’t cover or has limited coverage for out-of-network care. HMO members typically have a primary care doctor and must get referrals to see specialists.
Exclusive Provider Organizations (EPOs): EPOs generally limit coverage to care from providers in the EPO’s network (except in an emergency). These providers may bill you for some additional costs.
Talk to an agent at Unity Health Advisors to discuss what option is best for you.