Do you know the difference between HMO, PPO, and POS health insurance plans?
Even if you think you're sure you do, it's worth making sure you understand the differences when you're considering what type of coverage best meets your needs.
Please see the chart below for details about these types of plans.
| HMO Health Maintenance Organization |
PPO Preferred Provider Organization |
POS Point of Service |
|
| Annual Deductible | HMO Health Maintenance Organization No, most plans | PPO Preferred Provider Organization Yes, most plans | POS Point of Service No, for in-network coverage on most plans |
| Set Copayment Amounts | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization No | POS Point of Service Yes, for in-network coverage |
| Coinsurance | HMO Health Maintenance Organization Yes, some plans | PPO Preferred Provider Organization Yes | POS Point of Service Yes, for out-of-network coverage |
| Out-of-Network Coverage | HMO Health Maintenance Organization Emergent care only | PPO Preferred Provider Organization Yes | POS Point of Service Yes |
| Primary Care Physician Required | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization No | POS Point of Service Yes |
| Referral Needed | HMO Health Maintenance Organization No* | PPO Preferred Provider Organization No | POS Point of Service No |
| Chiropractic Care or Spinal Manipulation Included | HMO Health Maintenance Organization Yes, QHP plans** | PPO Preferred Provider Organization Yes | POS Point of Service Yes, QHP plans** |
| Premium Cost | HMO Health Maintenance Organization $ | PPO Preferred Provider Organization $ | POS Point of Service $ |
| Individual and Family Coverage | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization Yes*** | POS Point of Service Yes*** |
| Preventive Care | HMO Health Maintenance Organization No charge | PPO Preferred Provider Organization No charge (in-network only) | POS Point of Service No charge (in-network only) |
| Lifetime Maximum | HMO Health Maintenance Organization No | PPO Preferred Provider Organization No | POS Point of Service No |
| Health Savings Account (HSA) | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization Yes | POS Point of Service Yes |
| Health Reimbursement Arrangement (HRA) | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization Yes | POS Point of Service Yes |
| Flexible Spending Account (FSA)**** | HMO Health Maintenance Organization Yes | PPO Preferred Provider Organization Yes | POS Point of Service Yes |
*Sentara Health Plans does not require referrals for HMO plans; however other insurance carriers may require a referral for specialist treatment.
**Spinal manipulation is covered under all Affordable Care Act-compliant qualified health plans (QHP).
***Sentara Health Plans does not currently offer Individual & Family PPO or POS plans.
****Flexible Spending Accounts are generally offered by an employer and are not specifically tied to a health plan.
Funding Options for Consumer Driven Plans
| HSA Health Savings Account |
FSA Flexible Spending Account |
HRA Health Reimbursement Account |
|
| Who Contributes? | HSA Health Savings Account Employee and/or Employer | FSA Flexible Spending Account Employee | HRA Health Reimbursement Account Employee and/or Employer |
| Pre-Tax Contribution? | HSA Health Savings Account Yes | FSA Flexible Spending Account Yes | HRA Health Reimbursement Account Yes |
| Uses | HSA Health Savings Account Qualified medical expenses | FSA Flexible Spending Account Qualified medical expenses | HRA Health Reimbursement Account Qualified medical expenses |
| Unused Funds at End of Year | HSA Health Savings Account Roll over to next year | FSA Flexible Spending Account Use it or lose it | HRA Health Reimbursement Account Given back to employer |
- Quality, affordable health insurance plans for individuals, families and businesses.