HMO, PPO, POS, PFFS: What do all these acronyms mean?
Who is this for?
If you're new to Medicare, this information will help you understand some common terms.
If you've been shopping for Medicare Advantage plans, you've probably noticed a lot of acronyms. HMO, POS, PPO, PFFS – all of these signify different plan types.
We’ll spell it out for you.
- HMO stands for health maintenance organization.
- POS stands for point of service.
- PPO stands for preferred provider organization.
- PFFS stands for private fee for service.
All these plans use a network of doctors and hospitals. The difference is how big those networks are and how you use them.
Navigating the health care industry on your own can be complicated. There are lots of doctors out there. And it's hard to know which ones will be the right fit for you. At times, you might feel like you're the only one advocating for your health. HMO plans help with that.
When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and refer you to trusted doctors and specialists in your network.
Here's an example of how an HMO plan works.
Another thing to know about HMO plans is that most health care isn't covered outside your network. That means if you're traveling outside your coverage area, we'll only cover emergency or urgent care in most cases.
You have to live in Michigan for at least six months out of the year to get one of our HMO plans.
HMO-POS plans work a lot like HMO plans. The main difference is that you can see doctors outside your network in some cases. That's where the "POS," or "point of service" part comes in. Each insurance company implements this a little differently.
With our HMO-POS plans, it means you can get routine health care when you travel outside Michigan but within the U.S. That’s because these plans have a program called BlueCard®, which is a national network of Blues doctors.
Here's an example of how BlueCard works when you're outside Michigan.
You have to live in of one of these 69 counties in Michigan for at least six months out of the year to get one of our HMO-POS plans.
You can read more about BlueCard and getting care while traveling in our Help Center.
PPO plans have more flexibility than HMO plans. You don’t need a primary care physician, and you can go to a specialist directly. You don’t need referrals. You can see doctors inside or outside your network. But if you stay in your network, you’ll pay less.
Here's an example of how a PPO plan works.
Our Private Fee for Service, or PFFS, plan covers medical services only. You'll pay more toward your premium, but once you meet your deductible, you'll pay less for health care services.
Here's an example of how a PFFS plan works.
Which one is right for me?
If you want low monthly premiums and copays and you don’t travel much, an HMO plan might be right for you.
If you do a lot of traveling within the U.S. and you want the convenience of having one doctor coordinating all your care, an HMO-POS plan might be right for you.
If you want to be able to coordinate your own health care and see specialists without a referral, a PPO plan might be right for you.
All our Medicare Advantage plans help cover emergency care outside the U.S.