By recei Managed Care Organization (MCO): A Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are common types of Managed Care Organizations (MCO). HMOs typically require participants to select a primary care physician, while PPOs offer more flexibility in choosing healthcare providers. Both HMOs and PPOs aim to control costs and streamline healthcare services through their provider networks.
There are four types of managed care organizations or plans:
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Exclusive Provider Organization (EPO)
Point Of Service (POS)
Explanation:
1)Preferred Provider Organization (PPO)
a)This plan allows in-network as well as out of-network benefits.
b)PPOs are very popular plans because they offer more flexibility than other plans.
c)One has to pay a higher premium and out-of-pocket for it than other plans.
d)A primary care physician (PCP) visit is not required and there is no referral required to visit any specialist.
2) HMO (Health Maintenance Organization)
a)This plan allows in-network benefits only.
b)One has to pay a less premium and out-of-pocket for it than PPOs plan.
c)The patient needs to visit PCP before visiting a specialist which means referral is required.
3) EPO (Exclusive provider organization)
a)This plan allows in-network benefits only.
b)One has to pay less premium and out-of-pocket for it than PPOs but more than HMOs.
c)EPOs offer more flexibility than HMOs as patients do not need referral from PCP.
d)To visit a specialist but the patient needs to pay the full cost of out-of-network care.
4) POS (Point of service)
a)This plan allows out-of-network benefits.
b)One has to pay a higher premium and out-of-pocket for it out since providers are out-of-network.
c)The patient needs to get a referral from PCP before visiting a specialist