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It might be a lot simpler if there were only one type of health insurance plan, but it wouldn't necessarily be better for you. Having options means it's easier to find a plan that fits your needs—both for your health and your budget. And don't worry—we'll help you figure out the differences between plans. You'll see it's really not so complicated once you take a closer look. Here's a brief description of the three main types of managed care plans:

HMO: Health Maintenance Organization

  • You choose a primary care provider (PCP) from within a health plan's network
  • Your PCP coordinates all your care and refers you to medical specialists when needed
  • Low out-of-pocket expenses, as long as your doctors and hospitals are members of your HMO plan's network

POS: Point-of-Service

  • You choose a PCP within your health plan's network to coordinate your care
  • You don't need a PCP referral to see a specialist, as long as the doctor is within your plan's network; Costs will be higher without the PCP referral
  • Your costs are higher when you go outside your network
  • No deductible when you coordinate your care with your PCP

PPO: Preferred Provider Organization

  • Greater flexibility than an HMO
  • You have a network of doctors to choose from, but don't need to name one doctor as your PCP
  • If you use doctors and hospitals from outside of your PPO network, it may cost more
  • You do not need a referral from your PCP to see a specialist
  • Your out-of-pocket health care costs may be higher
  • Some plans have deductibles before benefits are paid; amount varies between plans
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For Blue Cross Blue Shield of Massachusetts members

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