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Types of Plans
HMO, PPO, POS, CDHP. Although this sounds like alphabet soup, these are actually all health plans designed with consumers’ different needs in mind.
Health Maintenance Organization (HMO)
When you choose an HMO, you are choosing to work with a primary care physician (PCP) to coordinate your care through in-network providers. When visiting a specialist or receiving care, a referral written by your PCP is often required for the services to be covered. There are generally no benefits if you choose to see an out-of-network provider.
Preferred Provider Organization (PPO)
If you want the freedom to manage your own care without referrals, then a PPO may be right for you. With a PPO, members can receive care from any provider, either in- or out-of-network, without a referral.
A POS plan combines elements of an HMO and a PPO. Like an HMO, the POS option has participants select a PCP, although members may receive medical care from both in- and out-of-network providers. If a member gets a referral, they receive the maximum benefit from their plan. If they receive care without a referral, then they will pay higher out-of-pocket costs.
Consumer-Driven Health Plans (CDHP)
These plans, which may also be referred to as high deductible health plans (HDHP), describe a relatively new way of thinking about health care that is gaining momentum. It is founded largely on the belief that consumers want more control over their health care decisions and how their health care dollars are spent. This plan pairs high deductibles with low premiums and a pretax health savings account, like an HRA, HSA, or FSA, that can be used for health services or saved for future health expenditures.