What you need to know

Explain the characteristics between: HMOs, PPOs, POSs and other plans (see health insurance product continuum)

Preferred provider organization (PPO):

A health care organization composed of physicians, hospitals, or other providers that provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received (fee-per-service) instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for out-of-network services.

Health maintenance organization (HMO):

HMOs are health plans that assume both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to its members, usually in return for a fixed, prepaid fee. Financial risk may be shared with the providers participating in the HMO. An HMO is a “closed panel” which (generally speaking) does not offer access to providers who are not a part of the HMO. Think of it as “in-network” only.

Consumer-driven health plan (CDHP):

CDHP is a broad definition incorporating several emerging healthcare strategies that heighten consumer awareness. Through various plan incentives a CDHP lays out the cost and utilization of healthcare services. It describes numerous mechanisms for providing health insurance or funds healthcare costs, all of which encourage individuals to become actively involved in making their own decisions regarding their health.

Coaches' Takeaway

Please refer to the information above.

Tools & Resources

CDHPCoach’s Storage Facility, where the Coach has organized and compiled a vast amount of tools and resources for you to access.


Housed here are key components and information within the book, Bend the Healthcare Trend which was the impetus behind the CDHPCoach.


What you need to know