Healthcare

POS

A POS, or point of service plan, is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. When patients venture out of the network, they’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider, in which case, the medical plan will pick up the tab.

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PPO

Preferred provider organizations (PPOs) generally offer a wider choice of providers than HMOs. Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician. However, straying from the PPO network means that participants may pay a greater share of the costs.

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HMO

Health maintenance organizations (HMOs) offer predictable cost-sharing and administrative simplicity for patients. These features come with fairly restrictive rules about which providers patients may see. Participants are entitled to doctor visits, preventive care and medical treatment from providers who are in the HMO’s network.

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Getting Started

Trying to purchase health insurance can be a time consuming and confusing process, and it only gets more complicated when you look into offering group coverage for your employees. Use our simple explainers to navigate your options and find a plan that works for you and your business.

Lifetime cap

Prior to the passage of the ACA, insurance providers could impose a limit on the total amount of benefits you could receive throughout your lifetime. For example, the lifetime cap could be set at $1 million, and if an insurer reached that amount of spending on your health coverage, they could stop paying for your coverage. ACA-compliant plans are prohibited from imposing lifetime caps, but non-ACA compliant plans may not provide this protection.

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