Understandably, there is a lot of confusion about the types of plans because there are no industry-wide definitions and because state standards are different.

To help you better understand the different types of plans, here are some generalities:

Health Maintenance Organizations (HMO): HMOs only cover care provided by doctors and hospitals within the network.

Preferred Provider Organizations (PPO): PPOs cover care in and out of the plan provider’s network. There is typically a higher percentage of the cost for care provided out-of-network, paid for by the members.

Exclusive Provider Organizations (EPO): EPOs generally do not cover care outside of the plan provider’s network. They are similar to HMOs, but members may not need a referral to see a specialist.

Point of Service (POS): POS plans often combine aspects of HMOs and PPOs. There may be coverage for out-of-network care that comes with higher cost sharing. Members also may need a referral to see a specialist.

There is a lot of variety from one plan to the next, despite how the plans are labeled.

When looking at plans, make sure to ask some basic questions about coverage, such as:

• If members are required to have a primary care physician,
• If members are required to get referrals for specialists or services,
• If any healthcare services need to be pre-authorized,
• If there is out-of-network coverage, and
• If there is out-of-network coverage, does spending count toward the out-of-pocket maximum?

All this month we are answering your questions and we will be answering even more in this month’s webinar Ask Lori-Ann Your Healthcare Questions on January 27, 2016 at 2 p.m. Eastern. Reserve your spot now! Bring your questions to the webinar or submit them in advance by email or on Facebook or Twitter.

The post What is the difference between HMO, PPO, POS, and EPS? appeared first on MyHealthSpin.