Which type of health insurance is better for a family of 4 in Madison, Wisconsin - PPO, HMO or POS?

HMO, PPO & POS Health Insurance for a Family of Four – Which is Better?

Finding the right health insurance for a family of four depends on a number of factors, including the age of the family members, whether the children are adult children or under age 18 and, of course, the budget.


First, determine the type of health insurance plan – HMO, PPO or POS.


Health Maintenance Organization (HMO) plans are designed to cover health care services within a specific geographic area. These types of plans are economical when in-network health care providers are used to provide health insurance for the entire family. If you go out of this network, you will generally pay the full cost of health care (except for emergency care). These plans require you to have a Primary Care Provider (PCP), usually a doctor who coordinates all of your care. Some HMO plans require you to get a referral from your PCP before seeing a specialist for any covered member of your family.


Preferred Provider Organization (PPO) plans provide a larger (sometimes nationwide) network of doctors and hospitals to choose from. They will pay a portion of the cost if you see an out-of-network provider, but an in-network provider will cost you less out-of-pocket. These plans usually don’t require members to have a PCP and most plans don’t require a referral before seeing a specialist.


Point of Service (POS) plans are a combination of the HMO and PPO health insurance plans – members can go out of the network for health care, but they will pay a higher share of the cost. POS plans generally require a PCP to refer you to a specialist.

 

What is the right type of health insurance for your family?

Young family – If your children are younger and all live at home, an HMO plan might be the best bet, because you can save money by using in-network health care providers. Be sure to review the network to make sure it has the doctors, specialists, hospitals and clinics you want. Also, check to see if you are assigned a PCP or if you can choose your own. For example, with Unity HMO plans, you choose your PCP and you may not need a referral to see a specialist. This may be an important consideration for a young family.


Family with children living away from home – If one or more of your children on your plan live away from home, or one of the parents travels extensively, a PPO or POS plan might be the right choice. These plans offer a larger network and cover a portion of the cost if an out-of-network provider is used.


Family of four living in a rural area – Sometimes HMO health insurance networks don’t have good coverage in every rural area. In this case, it might make sense to look at a PPO to access more providers. Even with a PPO plan, it’s still important to check the doctors, specialists, hospitals and clinics in the network to make sure the providers you use the most are in-network.

 

Still wondering about the best health insurance for your family of 4?  Get a Quote for a family health plan, or give us a call at 800.362.3310. We’ll help you find the plan that’s right for you, with access to the doctors, specialists and hospitals you want.