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Health Insurance Plan Options

With the costs of health care on the rise, a good health insurance plan is vital to preventing and quickly detecting and treating illness and disease. Those who have active medical insurance plans are more likely to follow through on yearly visits to their doctors and to adhere to the healthcare advice they are given. Those who do not have medical insurance often rationalize that the expense outweighs the risk and many of those pay for it in the long run.

There are four main types of medical insurance plans; Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Fee-for-Service or Major Medical, and Point of Service (POS).

Health Maintenance Organizations (HMO)

Set up as a quaint little community, HMOs operate within a small network that requires those using an HMO plan to utilize the facilities, doctors and staff that work within the group. While HMOs do offer some benefits for providers outside the network, the benefit greatly decreases and there are a significantly higher number of hoops to jump through and many are only approved in cases of emergency. Premiums are typically paid on a monthly basis, but in order to try to save money – both yours and theirs – HMOs heavily focus on preventative care and a large portion of the benefit comes to those who utilize their wellness checks and yearly visits to help with early detection and prevention.

Preferred Provider Organization (PPO)

A PPO is a little different in that it works as a combination of both an HMO and a Fee-for-Service plan. A PPO also maintains a network of providers that are covered wholly. But, it is up to the discretion of the insured to choose a provider outside of the network at a reduced coverage rate.

Fee-for-Service/Major Medical Plan

This type of plan is the most common amongst today’s insured. In a Fee-for-Service plan, the insurance company typically offers 80/20 coverage, meaning that after a specified deductible (usually with a set out-of-pocket limit) is met, the insurer will cover 80% of expenses while expecting the insured to cover or pay the remaining 20%. They do not operate within a network and therefore the insured may select any doctor or facility where they would like service.

Point-of-Service Plans (POS)

A Point-of-Service plan is supplemental with HMOs and is only offered with recommendations or referrals from the insured’s primary care physician to receive insurance for out-of-network providers. If the insured visits a non-network provider without a referral, the insurance company may choose not to pay anything toward that visit.

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