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Adulting: Understanding Health Insurance (Pt. 3)


Some of you may be familiar with my Real Homies Wanna Know YouTube series, where I talk about general topics that people may be familiar/unfamiliar with. There's one topic that I'm sure real homies wanna know about and it relates to HMO's, PPO's, and POS'. What the heck do these abbreviations mean?! If you drew a blank, don't worry, we're all learning here and that's the purpose of this post. I've already shared in my last post my dislike for abbreviations. Nothing has changed since then (ha ha). I mean, wouldn't it be nice if along with those abbreviations there was a simple explanation of what each of them are? Yes, it would be nice and that's what you're going to get today. I'll keep this one short and sweet!

So far we've covered important health insurance terms, the difference between In and Out-of-Network, and financial accounts that help you pay for medical services. Now that we know these terms, we can apply them to the type of plan we have/searching for and from there we are WINNING!

HMO's, PPO's, and POS', Oh My!

You'd be surprised at how many people have no idea what type of plan they selected during open enrollment, or what that means for them. The most they may know is the premium because it's all about the Benjamin's, baby (Benjamins = money). However, when purchasing a health insurance plan, the most important thing for you to know is the TYPE of plan you are getting.

Remember the health literacy definition? As a whole, health literacy focuses on you being able to determine which health insurance coverage will benefit your health AND your pockets. *(1) Find, (2) evaluate information, (3) select and (4) use.* I know this is getting repetitive with throwing the health literacy definition in these posts, but SO?!

When we find plans like HMO, PPO, and POS, our next step is to evaluate that information and figure out which plan will be most fitting for our healthcare needs. Meaning, get a clear understanding of what each of those terms mean and how it applies to our lives before we take the next step, which is selecting a plan. The last thing we want to do is select a plan and have expectations that don't exist. If we don't understand the type of plan we have, well it could possibly land us in a big pile *Siiiigh

Image by Christina Peoples

Health Maintenance Organization (HMO): this type of plan limits you to only being able to receive services from providers (physicians/hospitals/etc) who participate (contracted) with HMO's. Also, the only time you can receive services from an Out-of-Network provider is when there is an emergency situation (life threatening). *It is important that you confirm your physician's network status before receiving services* With this plan, you are required to have a primary care physician (PCP) assigned to you. In order to visit a specialist, or have specific services like Physical Therapy and X-Rays, you must see your PCP first and get a referral before going. HMO's are set up to coordinate your care. By visiting your PCP first, he or she is in a better position to ensure you are seeing the most appropriate provider to care for your medical concerns. *Just because your PCP gives you a referral, it does not always mean the provider they refer you to is INN. Always confirm.*

Preferred Provider Organization (PPO): this plan allows you to see providers who are either INN or OON. The benefits are normally the same for both, however the cost is lower if you use providers who are INN. There is also no need to have a referral to see a specialist. You have more flexibility with a PPO than you would an HMO, as it relates to not being restricted to just INN providers.

Point of Service (POS): POS plans allow you to see a provider who is INN/OON. However, the benefits are usually different depending on if the provider is INN or OON (If you're still a little cloudy on the difference between INN/OON, be sure to refer to last week's post). Keep in mind the benefits are higher when you use providers who are contracted with your plan.

Exclusive Provider Organization (EPO): this plan is INN benefits only. Meaning, you can only see providers who are contracted with your insurance plan, unless there is an emergency situation. It usually does not require referrals to see a specialist. This plan is straight to the point!

Decisions, Decisions

When making decisions related to your health, it's good to ask yourself some questions to gauge how beneficial each choice will be for you. Here's a few questions to ask yourself when you are in the process of selecting a plan:

1. Is your physician INN with the plan you are considering?

2. Are you okay with being limited to using only INN providers - - i.e. if you have established a great relationship with your current physician and he/she is not INN, will you be okay with that?

3. Can you see your big picture with this plan - - i.e. if something unexpected were to happen, will this plan be helpful? If you frequently receive medical services, does the picture show you saving money or losing money?

So, Now What?

Now that we have clear definitions of what an HMO, PPO, POS and EPO is, we can better understand our current or future insurance plans and any limitations or requirements they may have. For open enrollment, most insurance companies will provide a summary of benefits that will further explain the types of services that are covered under your plan. You can also have access to their website, where you will be able to do a provider look-up and confirm if a specific doctor/facility is contracted with the type of plan you desire. The bottom line is, once you have done your RESEARCH and directed your necessary questions to your HR representative or Insurance representative, you're on the right track to being health insurance literate!

The More You Know

Doesn't it feel good having a better idea about healthcare abbreviations?! Now you can understand how your plan works and all the other ish that comes along with it. Research. Research. Research. Doing our research and understanding/asking questions about our findings will ALWAYS be the key to choosing wisely and saving them dollar bills. We're getting closer to the finale and I'm excited! I'm loving the feedback about this Adulting series and I'm glad to know it's helping.

In the meantime in between time, be sure to follow me on Instagram: @gero_what or the Gero-what Facebook Page. Don't be shy, leave a comment and let me know what your experience with finding a provider in the network has been like. Stay tuned for the finale on next week!!!!

Be Blessed,


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