A Buffet with Only 4 Options – Sounds like our Health Insurance

Sorry – you can’t get seconds…

…because we’re talking about your Health Insurance options. Sorry if you’re mouth just started watering thinking of a hefty Golden Corral Buffet. To follow up on our Healthcare Series since it is ENROLLMENT time for many, we’re touching on the slightly more detailed explanation of the 4 insurance plans you’ll most likely run into. I’ve been fortunate to enjoy 2 different types of plans through my short 12 year career in sales (PPO and HMO), which also afforded me the opportunity to play with both an FSA and HSA at different times.

The classic buffet: PPOs and HMOs

These are the plans the everyday person has heard of. The classic buffet food that everyone knows and loves. These are the most common because if you take a look at the out of network costs, providers, etc. they tend to be a bit more flexible. They also have the the typical plan “categories” as mentioned in our last post and some even have different “models.”

Preferred Provider Organization (PPO): One of the most flexible. This is typically used in conjunction with an FSA since they are not normally high deductible plans, but that could change depending on the category (Silver, Bronze, Gold). PPOs allow you to see out-of-network providers without a referral for an additional cost and you pay less for in-network providers. The lack of a referral is a great benefit. All that means is instead of going to your Primary Care Physician (the guy or girl who does your physical every year), you can go straight to a specialist and save a bit of money.

Health Maintenance Organization (HMO): A little less flexible. Sometimes used with an HSA because this might have a higher deductible. Care coverage is typically restricted to those providers in-network with the HMO and out-of-network is only covered in emergencies. They also require you to be in a specific area for coverage (they call it a service area). The positive here is that HMOs also put an emphasis (focus) on prevention and wellness.

I’m currently enrolled in a PPO and as a single male with no dependents (kiddos) it’s a pretty great plan. I have endured neck procedures in the last few years and with my FSA working with coverage, the experience has been great.

I’ve experienced an HMO when I was making a much higher W2 income and had an HSA. The deductible was much higher, but I also wasn’t experiencing many health issues or went to the doctor/urgent care as much. This includes any of the check-ups or preventative measures. I pay a bit more attention to my health now that I’m a pilot.

Based on my current situation and health, I plan to stick with PPOs for the foreseeable future. The coverage, premium, current employment payments, and deductible all make this the choice for me. The only change I’d make is to find a PPO that potentially had a High Deductible plan so I could utilize an HSA.

The special food you don’t always get…

…Either a really good dessert or that weird asparagus casserole you kinda like but never really see at a buffet. That’s the POS and EPO plans. I don’t have experience with these, but can share that they seem a bit less flexible than the HMO and PPO.

Point of Service (POS): This is similar to an HMO because you are incentivized to see providers in-network. The difference is that you’ll pay less seeing providers and hospitals in-network. They do require you to see you’re Primary Care Provider before getting a referral to a specialist meaning you have to see your regular doctor first to get sent to someone like a Neurologist.

Exclusive Provider Organization (EPO): Also similar to an HMO, but only covered if you seen a provider or hospital in-network. They do have the exception for an emergency. 

I haven’t used either one of these, but they do lean closer to an HMO and don’t necessarily provide the flexibility of the other plans.

This makes your choice easy

Kind of. Not really. Healthcare is or should be unique for everyone. We all have different situations, families, and events that require a degree of flexibility. While it looks like we have choice you can clearly tell a lot of the plans are the same in most aspects with the only change in costs when you pick a different “category.” Now by doing this research it was nice to see that some plans focus on preventative wellness and some categories even offer discounts. At the end of the day though our choices truly are a bit limited.

Remember though – just because our choices are limited doesn’t mean we can make some positive moves with the information presented to us. Prep yourself with this information, do a bit of research, and make the most of this upcoming enrollment period!

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