Knowing what the names describing your plan mean will go a long way in helping you know what to expect from a plan. These features apply across the board with slight variations:
- Health Maintenance Organization (HMO) Your healthcare is managed through a Primary Care Physician (PCP), who refers you to specialists when needed. Generally, you pay a copay (a set flat fee) for medical services included in your plan’s benefits. All medical care must be received in-network.
- Preferred Provider Organization (PPO) You can choose from in-network and out-of-network healthcare providers. But if you do go out-of-network, you end up paying a lot more. You don’t need to choose a PCP, and no referrals are required in order to see a specialist.
- Exclusive Provider Organization (EPO) This plan is generally the same as a PPO, except that you can only choose doctors in-network.
- Point of Service (POS) A hybrid between an HMO and a PPO. Like a PPO, you can choose from in-network or out-of-network providers. Again, you pay more if you go out-of-network. In-network, plan benefits are copay based (like an HMO). You may need referrals from a PCP to see specialists.
- High Deductible Health Plan (HDHP) There are a variety of plans that fit into this category, including PPO and EPO. For a lower monthly premium, these feature a higher deductible (the amount you must pay for medical services each year) than traditional plans and have no copays. Some plans are "health savings account (HSA) qualified", meaning that they come with an account into which you can deposit money tax-free to be used for healthcare expenses.
- Indemnity Also called "hospital-only", these are low-cost plans that provide coverage for hospitalization and one preventive care visit to a physician and gynecologist per year. Indemnity plan subscribers are considered uninsured: if you switch from an indemnity plan to a major medical plan any conditions you have may be considered pre-existing and may impact your eligibility and benefits, but it is a cost-effective alternative if traditional plans are not in your price range.
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