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HMO plans require a person to select a primary care physician (PCP), but they do not need to do so with a PPO plan. HMO plans also require a referral to see a specialist, but PPO plans do not.
This model is an example of a closed-panel HMO, meaning that contracted physicians may only see HMO patients. Previously this type of HMO was common, although currently it is nearly inactive. [7] In the group model, the HMO does not employ the physicians directly, but contracts with a multi-specialty physician group practice. Individual ...
Unlike POS and HMO plans, however, EPOs allow you to choose your own PCP and see specialists without a referral. Although these plans do come with copays and deductibles, they are usually on the ...
The most popular type of plan is a Medicare Advantage HMO (Health Maintenance Organization). ... But you won’t need a referral to see a specialist. PPOs typically have higher cost-sharing and ...
For example, if patients stay in a network of providers and seeks a referral to use a specialist, they may have a copayment only. However, if they use an out of network provider but do not seek a referral, they will pay more. POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.
But POS health insurance does differ from other managed care plans. Enrollees in a POS plan are required to choose a primary care physician (PCP) from within the health care network; this PCP becomes their "point of service". The PCP may make referrals outside the network, but with lesser compensation offered by the patient's health insurance ...
In the case of HMOs, you must have a referral from another doctor, which can be an annoyance. Alternatively, if you go with a PPO plan, you may have higher out-of-network costs should the need arise.
The Health Maintenance Organization Act of 1973 (Pub. L. 93-222 codified as 42 U.S.C. §300e) is a United States statute enacted on December 29, 1973. The Health Maintenance Organization Act, informally known as the federal HMO Act, is a federal law that provides for a trial federal program to promote and encourage the development of health maintenance organizations (HMOs).