This page is meant to give a brief overview of some of the major types of health insurance plans that are available.  It should be noted that the descriptions below are generalizations and that within each of these categories there is an enormous variety of terms and pricing depending on what state you live in, what company is offering the plan, and many other factors.


HMO

Health Maintenence Organization

  • You pay a monthly premium
  • You make small set co-payments that are not based on a percentage when you get care or other services
  • Requires patients to stay within a relatively strict network of health care providers
  • Almost always have to choose one doctor as your primary care provider 
  • HMOs often provide good basic, preventative care
 

PPO

Preferred Provider Organization 

  • Very similar to HMO 
  • Generally allows more choice of doctors and providers than HMO
  • Consequently, costs more than comparable HMOs
  • Allows people to visit doctors and specialists outside the network and still receive some coverage
 

FFS

Fee-for-Service Plan

  • You pay a monthly premium
  • After you reach your deductible, you begin paying a coninsurance percentage
  • Eventually there is a cap on the amount you have to pay out of pocket, and you no longer have to pay coinsurance for medical fees beyond that point (though you still pay your premium)
  • Offers the most choice of doctors, hospitals, and other providers
  • You must keep track of all of your own medical expenses 

Two kinds of FFS coverage:

Basic

  • Covers care given in hospital: room, services, x-rays, and medicine
  • Also contributes to surgery costs and the cost of certain doctors 

Major Medical

  • Covers the cost of long-term illnesses and injuries
  • Picks up where basic coverage leaves off

"Comprehensive" plans include both basic and major medical coverage


POS

Point-of-Service Plan

  • First you choose a primary care provider who, ideally, has agreed to provide services at a discounted rate
  • From there on, when you need any kind of medical attention, you must first contact this primary POS physician and be referred to a specialist in order to receive the greatest benefit from the plan

Hospital Indemnity Insurance

Pays a fixed value for each day spent in hospital

  • Only pays for a limited number of days
  • Can be used for a wide variety of expenses
  • Benefits may or may not be coordinated if you another policy that is paying concurrently paying for your hospital expenses