Week 9 Discussion Topic
A friend, who has been a dependent on her parents’ insurance, recently graduated from college and was
offered a full-time healthcare management position. When she started to complete her human
resource (HR) application, the HR manager asked her what type of healthcare plan she chose. Her new
employer offered several different healthcare plans: fee for service, HMO, PPO, and POS plans. She was
very confused and asked you to explain the managed care plans to her.
Describe the characteristics of HMO, PPO, and POS healthcare plans and identify the differences
between the HMO and PPO plans. Make sure you explain so your friend can understand.
Here are the discussion board requirements.
The initial discussion post must be at least 250 words of content, referencing the reading of the week,
and include a scholarly source.
All initial posts need a reference. Your initial post should never be all opinion. You need to refer to the
reading and required resources.
Student Responses:
Angelica Albut,
Part 1: Describe the characteristics of HMO, PPO, and POS healthcare plans.
Health Maintenance Organizations (HMOs)
In a very general sense, HMOs offer predictable cost-sharing and administrative simplicity for patients.
These features come with fairly restrictive rules about which providers patients may see. Participants
are entitled to doctor visits, preventive care and medical treatment from providers who are in the
HMO’s network. Participants usually need to pay a small fee at the time of service called a copay (often
in the range of $10 to $30) while the HMO covers 100% of the services provided. HMOs typically require
patients to select a “primary care physician” (PCP) who can refer patients to specialists, also within the
HMO’s network. HMOs often won’t pay for medical care that wasn’t referred by the primary care
physician (some exceptions include emergency services or preventive gynecological exams).
Preferred Provider Organizations (PPOs)
PPOs generally offer a wider choice of providers than HMOs. PPOs allow participants to venture out of
the provider network at their discretion and do not require a referral from a primary care physician.
However, straying from the PPO network means that participants may pay a greater share of the costs.
Point-of-Service Plans (POS)
A POS is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants
designate an in-network physician to be their primary care provider. But like a PPO, patients may go
outside of the provider network for health care services. When patients venture out of the network,
they’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-ofnetwork provider, in which case, the medical plan will pick up the tab.
Part 2: Identify the differences between the HMO and PPO plans.
The biggest differences between an HMO and a PPO plan are:
Patients in with an HMO must always first see their primary care physician (PCP). If your PCP can’t treat
the problem, they will refer you to an in-network specialist. With a PPO plan, you can see a specialist
without a referral. (there are exceptions for emergencies or routine-care).
With an HMO plan, you must stay within your network of providers to receive coverage. Under a PPO
plan, patients still have a network of providers, but they aren’t restricted to seeing just those physicians.
You have the freedom to visit any healthcare provider you wish.
Other differences include:
Costs of plans.
The services they cover.
How each plan goes about filing a claim.
Prescription coverages.
When it comes to health insurance, identifying the differences between each plan can be challenging for
anyone. Breaking down the differences in costs and what each healthcare plan provides can help you
understand which plan would most benefit you. Although it may seem like they’re all the same concept
understanding the main difference which are the costs can help determine which one is more affordable
to you this way you are not applying for insurance that you will not be able to keep up with financially.
Anniopali Pena
Health Maintenance Organizations (HMOs)
The definition of this type of health plan is that you must select a primary care physician, or PCP, who is
then the service center for all of your other health care needs. In an HMO, any time you need specialty
care, you’ll need a referral from your PCP, and all of your referrals must be within your HMO’s network.
That said, nothing prevents you from seeing a provider outside of your network, you’ll just have to pay
out of pocket.
Preferred Provider Organizations (PPOs)
PPOs do not require you to select a primary care physician and you do not need referrals to see
specialists. PPOs pay a larger portion of bills from preferred providers and a smaller portion of bills from
providers outside the preferred network. The best part about PPOs is that even out-of-state providers
may be preferred. You will probably pay higher monthly premiums for a PPO than for an HMO.
Point-of-Service Plans (POS)
POS, is also known as a “point of service” health care plan. Think of it as a combination of HMO and PPO
plans. You still need to select a primary care doctor and need referrals, but the cost of coverage is the
same as a PPO plan: more coverage for preferred providers and less for out-of-network providers.
I would advise my friend to determine his medical needs so that he can correctly determine what
benefits he needs. Each plan has its benefits, each person has different needs, the correct decision will
depend on the benefits that each person seeks.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Printed by: [email protected]. Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.

Purchase answer to see full
attachment