The Difference Between an HMO and a BLT


Hi all, more alphabet soup coming your way. This time we’re going to present not only a delicious sandwich recipe, but also help you distinguish the difference between the types of QHPs (Qualified Health Plans). These are health insurance plans offered through Maryland Health Connection. First things first, since we probably made you hungry, we’ll wait a minute while you go fix yourself a BLT (Bacon, Lettuce, and Tomato) sandwich.

Okay, perfect. Ready for these health plan terms? The most popular types of insurance plans Maryland Health Connection offers are Exclusive Provider Organization (EPO), Health Maintenance Organization (HMO), Point-of-Service (POS) and Preferred Provider Organization (PPO). You can see other available plan types here.

Some plan types allow you to see almost any doctor or health care facility; others limit your choices to a network of doctors and facilities or require you to pay more if you use providers outside the network. Remember, before you pick a plan you should check with your preferred doctor to be sure they’re “in network” -- you’ll pay less for services.


EPO is a type of health insurance plan where generally services are covered only if you use doctors, specialists or hospitals in the EPO’s network (except in an emergency). Members do not require referrals to see a specialist.

HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. An HMO generally won’t cover or has limited coverage for out-of-network care, except in an emergency. HMO members usually have a primary care doctor and must get referrals to see specialists. HMOs often provide integrated care and focus on prevention and wellness. In general, HMO plans are the least expensive plans that health insurance carriers offer.

POS is a type of health insurance plan where you can get medical care from both in-network and out-of-network providers. You’ll pay less if you use in-network doctors, hospitals, and other health care providers. If you have a POS plan, you’ll select a primary doctor from a list of participating providers. To visit an out-of-network provider, you’ll need a referral and you may pay higher out-of-pocket costs.

PPO is a type of health insurance plan where you have the choice of getting care from in-network or out-of-network providers. You’ll pay less if you use providers in the plan’s network. If you have a PPO plan, you can visit any primary care doctor or specialist without getting a referral, and you do not need to select a doctor to be your primary care physician to coordinate your care. Generally these are the most expensive plans a health insurance carrier offers.

About Maryland Health Connection

Maryland Health Connection is Maryland’s official health insurance marketplace for individuals and families to compare plans and enroll in health and dental coverage. It’s the only place to get financial help with health insurance. See if you qualify for financial help like tax credits or Medicaid/MCHP to make health insurance more affordable.

Visit MarylandHealthConnection.gov to enroll, or download our free Enroll MHC mobile app for Android and iPhones. Open Enrollment for 2017 is Nov.1 to Jan. 31.

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