Distinctions Among the Various Types of Health Plans

Q: I am trying to apply for health insurance in the Obamacare federal Marketplace because Florida has refused to create its own exchange. Can you explain the distinctions among the various types of health plans (ie, HMOs and EPOs)?

A: Kaiser Health News recently published a simple definition of the general types of health plans sold on the individual market. You can read the full article here: http://www.kaiserhealthnews.org/stories/2014/august/19/hows-a-consumer-to-know-what-health-plan-is-best.aspx. Below is an excerpt:

• Health maintenance organizations (HMOs) cover only care provided by doctors and hospitals inside the HMO’s network. HMOs often require members to get a referral from their primary care physician in order to see a specialist.
• Preferred provider organizations (PPOs) cover care provided both inside and outside the plan’s provider network. Members typically pay a higher percentage of the cost for out-of-network care.
• Exclusive provider organizations (EPOs) are a lot like HMOs: They generally don’t cover care outside the plan’s provider network. Members, however, may not need a referral to see a specialist.
• Point of Service (POS) plans vary, but they’re often a sort of hybrid HMO/PPO. Members may need a referral to see a specialist, but they may also have coverage for out-of-network care, though with higher cost sharing.