How does HMO, PPO, EPO, and POS plan varies from each other

What are HMO, PPO, EPO, and POS?

The simple answer is all those come under managed care, each has its own specification with pros and Cons. with the patient benefits, it may vary from one another. After reading the individual benefits of all the topics check the table added below so that you will get a good understanding. Let’s dive into the Topics!

What are the different types of managed care

  • PPO
  • HMO
  • EPO
  • POS

PPO- preferred provider organization

PPO insurance plans are probably the most common type of health insurance plan. This plan type permits you to patronize any health care provider of your liking without the need for a referral from your primary care doctor.

Usually, a PPO insurance plan covers medical services from out-of-network providers and in-network providers differently. This implies that while your policy covers the costs of seeing a doctor that’s out of network, it won’t cover as much as if you saw one who is in-network. Usually, you’ll have more out-of-pocket expenses if you go to an out-of-network doctor.

HMO-Health Maintenance Organization

This plan type allows you to contact doctors who are immediately available. This type serves as your general health caretaker and is responsible for coordinating your care with network physicians.

Let us see an example: If you have a Health Maintenance Organization. plan and need to see an orthopedist, your doctor must write you a referral to that orthopedist in your network. At that time, the specialist visit will be covered by your insurance. If you go to an orthopedist who is not in your network, your insurer will not cover you for the specialist’s services.

EPO-Exclusive Provider Organization

An EPO plan is currently less common than HMOs and PPOs but shares features of both. Similar to PPO insurance, you can go directly to a specialist and bypass the need for a referral from your primary care physician, however, just like HMO insurance, you won’t be covered if you see out-of-network providers.

POS- Point of Service Plan

This plan type combines the application of the HMO and PPO models. You or your primary treatment professional will fill in as the plan’s primary point of contact. Depending on the plan, you can get a medical referral to see a specialist for an additional cost. If you have a surgical procedure, you might need to get prior authorization from your insurer. For therapies that aren’t covered by your plan, such as medical and dental care, you may require a supplementary health plan.

Table of differentiation

Premium cost High Low Normal Normal
Pre-authorization required No No routinely routinely
Primary care physicians needed No referral Yes Yes Usually
Out of network coverage Covered as a low cost  Not covered Covered at a high cost Not covered
Specialist Visit Referral not needed Referral only  Referral only Referral not needed


In short, the above metrics depend on the plan, Time frame, medical conditions. before selecting the plan need to get in touch with the representative or the specialist to choose the best plan that suits you. Hope your doubts are clarified


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