Healthcare Insurance Plans

Health Maintenance Organization (HMO)

An HMO delivers all health services through a network of healthcare providers and facilities. With an HMO, you may have:

• The least freedom to choose your health care providers
• The least amount of paperwork compared to other plans
• A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan; most HMOs will require a referral before you can see a specialist.

Preferred Provider Organization (PPO)

Preferred provider organizations are a type of health plan. PPOs have a network of doctors, hospitals, and other providers who have agreed to charge less for plan members. Members of the health plan have access to a list of providers in the network by name and location. Generally, with a PPO, you do not need a referral from your primary care provider when you want to see a specialist. With PPO coverage, you may also choose to seek care from providers that do not participate in the plan’s network. However, going outside the network comes with additional costs.  

Point-of-Service Plan (POS)

A POS health plan stands for “point of service” and is a mix between an HMO and a PPO-style health insurance policy. With a POS health plan, you have more choices than with an HMO. You may need to select a primary care provider and need a referral to see a specialist. But with a POS plan you have the choice to use doctors, hospitals, and other providers that are not in your health plan’s network. However, you will have to pay more for using out-of-network providers.

High-Deductible Health Plan With or Without a Health Savings Account.

A high-deductible health plan (HDHP) has a higher deductible than most health plans, but it also has a lower monthly premium. The deductible is the amount you must pay yourself before your health plan pays its part for health care services. A premium is the amount you pay every month for your health plan. That means with an HDHP, you generally pay a smaller premium, but when you need health care, you pay more out of pocket before you get help covering your medical costs from the insurance company.

You can combine an HDHP with a health savings account (HSA). If you have employer-based health insurance, you may be eligible to combine your HDHP with a HSA or with a health reimbursement arrangement (HRA). With an HSA, you contribute pre-tax money to pay for health costs not covered by insurance, such as copays, coinsurance, or dental care. Your employer may also add to your HSA. Not all high-deductible plans can be used with a HSA. An HRA is similar to a HSA except the employer funds the account, not the employee.