Florida health coverage can take the form of four different managed care options. The most flexible and comprehensive type of managed care health insurance in Florida is the preferred provider organization, or PPO. In a PPO plan, the insured is given a list of in-network care providers and medical centers. If the insured opts to use one of the listed providers, the costs will be less, often with decreased co-payment amounts. This type of plan offers the insured the freedom to choose providers outside the network. Those costs will be covered by the plan, but as they are non-negotiated rates, they will be higher. The premiums paid for a PPO plan tend to be slightly more than those for other types of managed care policies, but with variations in deductible amounts, that cost can be offset.
The health maintenance organization or HMO is one of the most common managed care options for Florida health coverage. The idea behind the HMO is to focus on preventative and well visits with a primary care provider to help reduce more serious incidents of medical intervention. The HMO will charge the insured a fixed monthly fee and in return the insured will have access to the HMO's network of care providers. Usually HMO members will pay a set rate for office visits and prescriptions, called the copayment. If treatment is necessary by a provider outside the network, the insured must obtain the proper referrals for the costs associated with that treatment to be covered.
The point of service plan, or the POS, is probably the least understood of the managed care options for Florida health coverage. The POS plan also has a network of providers to allow for a lower negotiated cost to the insured. Under this type of plan, the insured may seek treatment outside the network, but will have to pay a higher percentage of co-insurance. Under a POS plan, there is usually an annual deductible amount that must be met before any costs will be paid for out of network treatments.
This fourth choice for Florida health coverage under a managed care plan is the exclusive provider organization, or EPO. In an EPO plan that is administered in this state, the insurance company contracts rates directly with the network providers and hospitals. The insured will only receive benefits from the plan if treatment is under the care of one of those network providers. There are generally no out of network provisions, unless the treatment stems from an emergency situation.