This article is about Justworks PEO. What product am I using?
Wondering what is an EPO vs PPO vs HDHP vs HMO vs POS? These are all different types of health insurance networks. Each type of network has it’s own rules about where you can receive care that will be covered by my insurance plan and what kind of care is covered by your plan.
What is the right health insurance network for me?
Before we learn about these network types, let’s focus on you! Do you have a favorite doctor or specialist that you like to see? Do you require ongoing medical services each month? Would you feel more comfortable paying most of the cost of services only when you need them or paying a predictable amount each month and then paying less when you actually need care?
Think about your answers to these questions as you read about the different types of networks.
EPO vs PPO vs HDHP vs HMO vs POS
We’ll break down what each of these network types are and why you might want to choose one over another.
EPO
EPO stands for Exclusive Provider Organization. With an EPO, I’m limited to a specific network of doctors and hospitals. I won’t need referrals to see specialists, but if I go out-of-network, I’ll pay out of pocket.
PPO
PPO stands for Preferred Provider Organization. This plan offers more flexibility, allowing me to see both in-network and out-of-network providers. I don’t need a referral for specialists. Out-of-network care is covered, but it’s more expensive. PPOs are ideal if I want the freedom to choose between in- and out-of-network providers and I am willing to pay a bit more for the flexibility.
For instance, some people value mental health counseling, but many mental health professionals don’t process billing through insurance carriers. A PPO might be a good option for someone who wants to work with out-of-network providers.
HDHPs & HSAs
HDHP stands for High Deductible Health Plans. These plans typically have lower premiums but higher deductibles. With a lower premium, I’ll pay less each month to be a member of my plan. I might choose a HDHP if I’m generally healthy and want to save on monthly premiums.
HDHPs are also compatible with Health Savings Accounts or HSAs, which allow me to save money tax-free for medical expenses and carry unused funds over into the next year.
HMO
We also have HMOs, or Health Maintenance Organizations. With an HMO, I choose a primary care physician, or PCP, who coordinates all my care and provides referrals to specialists. This is a cost-effective option, but it comes with less flexibility since out-of-network care is generally not covered.
POS
POS plans, or Point of Service, are a blend of HMO and PPO plans. POS plans require me to choose a primary care physician who coordinates my care and provides referrals for specialists. Like a PPO, a POS plan provides coverage for both in-network and out-of-network services, but out-of-network services typically cost more.
Disclaimer
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.