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What is the difference between HMO, PPO and POS?

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HMO stands for Health Maintenance Organization. An HMO is a group that contracts with medical facilities, physicians, employers and occasionally individual patients to provide medical care to a group of individuals. An HMO patient must select a Primary Care Physician (PCP) contracted with their HMO. The patient’s PCP is responsible for referring the patient to any and all additional providers (specialty care physicians, hospital, etc). HMO plans have no out-of-network reimbursement and patients who seek care from non-contracted providers will have no coverage. PPO stands for Preferred Provider Organization. PPO coverage encourages patient selection of a PCP, however, it is not mandatory since PPO plans allow patients direct access to all network physicians. PPO plans normally provide coverage for out-of-network providers, but the patients out-of-pocket for non-participating providers will be considerably higher than in-network care. POS stands for Point of Service. POS plans are a ... more
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