Managed Care Plans (HMO, PPO, POS, EPO) and Their Distinctive Features

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Managed Care Plans (HMO, PPO, POS, EPO) and Their Distinctive Features

Model Type	HMO	PPO	POS	EPO
Detailed description	One of the low-cost models to meet health care needs. The price is lowered by negotiating with specific hospitals and clinics and medical staff whose care is required. The patient is required to use only a limited list of providers, because otherwise the cost of collection will be greatly increased. As a consequence, along with a small financial outlay, the client receives little flexibility and variability in treatment.	The model in which the customer is required to stay in the network because otherwise the personal costs would far exceed the insurance. The financial cost of care is much higher than the other models because customers are required to make more expensive monthly premiums. Costs are only reduced if you use a network of physicians and providers, otherwise spending are increased. A PPO plan gives a lot of options for patients: The high flexibility allows you to choose your primary care physicians.	A model with three levels of service differs in the amount of annual and monthly service. Members have a network physician, so costs are relatively low. If you need to go out to non-participants, the amounts go up significantly. However, getting a referral from the POS to a specialist can lower the cost.	The model allows you to choose network providers and not go to the same physician. It makes the program flexible, but out-of-network care is not always covered. This accounts for the high cost of services and the range of specialists to whom referrals are made. Not the most expensive monthly package, which makes the model a more economical and affordable option than PPOs.
Example Health Plan	content.grantham.edu	content.grantham.edu	content.grantham.edu	content.grantham.edu
Annual deductible	0$	0$ for participants 5000$ for non-participants	0$ for HMO providers 400$ for participants and non-participants	2000$ for participants
Maximum out of pocket	7800$ for individuals	7800$ for participants 20000$ for non-participants	1500$ for HMO 4000$ for participants 6000$ for non-participants	6250$ for participants
Monthly Premium	18$	517$	50-100$	469$
Patient office co-pay primary care network MD	30$	30$	10$ for HMO 25$ for participants 30% for non-participants	45$
Patient office co-pay for specialist MD	Trio+Specialist 65$ Other+Specialist 65$	65$	10$ for HMO 20$ for participants 30% for non-participants	65$
Do you need a referral to see a specialist?	Yes	No	Yes	No
Prescriptions included?	Yes	Primarily no	No	Yes

Summary

Managed care plans offer guaranteed access to health care services at discounted rates. Although these plans are not that flexible, they do a great job of meeting patient and provider needs. The models differ in their cost, the list of services included and overall coverage, and the referral system for exams. Each model (HMO, PPO, POS, EPO) has distinctive features that allow the client to move freely on the basis of their health insurance.

The HMO benefits include low monthly service, prescription coverage, and referrals to specialists. Not the most flexible but affordable program for most people. The advantages of PPOs are in a comprehensive service network and excellent model flexibility. The guaranteed convenience and wide variability in choosing a doctor and clinic make PPO a good insurance choice (Araujo, 2021). The POS model is the most budget-friendly and straightforward insurance plan with three tiers. The variability in levels results in a difference in cost, but the quantity and quality of services remain top-notch (Health Insurance Marketplace, 2021). Finally, EPO is a simplified version of PPO, which is nonetheless just as expensive. Due to the lack of referrals, the monthly cost is likely to increase significantly. Because of the above, I would choose the POS model because it provides a treating physician, provides options for different levels, and has a reasonably vast coverage network.

Reference

Araujo, M. (2021). HMO, PPO, POS, EPO: Whats the difference? The balance, Web.

Health Insurance Marketplace. (2021). What you should know about provider networks. Web.

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