888-765-5400HMO, PPO, POS – Which Health Insurance Plan is For You?
Blue Cross Blue Shield of North Carolina understands that choosing a health insurance plan can be an overwhelming prospect, especially if you don’t fully understand the terminology. For instance, what is the difference between an HMO and a PPO and how will that affect you when it comes to using your health plan? Let’s break it down.
HMO stands for Health Maintenance Organization. HMO’s usually have lower monthly premiums, but they require Primary Care Physician (PCP) Referrals and won’t pay for out-of-network care. Typically, these health plans require you to have a referral from a PCP before you see a specialist or get other types of non-emergency care. Furthermore, if you use a health provider outside of the HMO’s network, you will be paying out of pocket expenses, except in some emergency situations. Blue Cross Blue Shield of North Carolina does not even offer HMO plans because of their restrictive nature.
PPO stands for Preferred Provider Organization. PPO’s, like HMO’s have a network of providers, but they will still pay out-of-network expenses. They are less restrictive than most other plan types, and usually do not require any kind of referrals. Because of this fact, however, they tend to have a little more expensive monthly premiums. Most BCBSNC health plans are PPO type plans.
POS stands for Point of Service Plan. POS plans are a hybrid between HMO’s and PPO’s. They are less restrictive than the typical HMO in that they still allow for out of network care. POS plans may, but rarely, require you to have a PCP referral. Some Blue Cross Blue Shield health plans are POS type plans.
HMO’s, PPO’s and POS’s all have provider networks. These networks are a list of doctors, hospitals, labs and other providers that are in some way contracted with the health plan. The difference really comes in how you are able to use health care services outside of your plan’s provider network. Whereas PPO’s will not require preauthorization, HMO’s most certainly will and plans that require preauthorization can be hard to use. Pre-authorization means that the health insurance company requires you to get permission for certain types of health care services before you can use that care and expect your insurance to cover you. Pre-authorization can take time and in some cases, you simply don’t have that kind of time before seeking the care you need.
When selecting a health plan, understanding these differences is paramount to being able to choose the kind of plan that is best for you and your family. Choosing a plan requires determining how many restrictions you are comfortable with and how much you are willing to pay monthly. Although low monthly health insurance premiums may seem tempting, if those premiums come with restrictions that limit your freedom of choice, the payoff may not be worth it. A PPO, though possibly more expensive, will give you flexibility and freedom to go out-of-network and see specialists without the hassle of a referral.
Blue Cross Blue Shield of North Carolina offers both PPO and POS type health plans available both on or off the federal Exchange. These plans will give you access to the broadest network of providers available in the state and will also cover you both in and out of network. For more information on Blue Cross Blue Shield of North Carolina insurance coverage, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.