·
What is a Health maintenance organization (HMO)?
· What is a Preferred
provider organization (PPO)?
· What is a Point
of service?
· What is a Fee for
service?
· What are Medical
savings accounts?
-
What
is a Health maintenance organization (HMO): This program
provides you with a list of physicians you can use. If you visit
a doctor on the list, and the visit usually only carries a $10-
$20 co-payment. HMOs usually offer the lowest premiums. However,
if you use a doctor not on the HMO provider list, you pay the
full amount of the visit.
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-
Preferred
provider organization (PPO): This provides more flexibility
than an HMO. You may use a doctor on the list and the co-pay
will be modest. Additionally, you also have the option of using
a doctor outside the network. In that instance, you pay the
bill and then submit it for reimbursement. The added flexibility
means PPOs generally have higher premiums than HMOs.
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Point
of service: A hybrid between an HMO and a PPO. If you
Stay within the network the plan will pay the medical bill.
If you go out of the network, you'll probably pay most of the
bill yourself. The exception is if your HMO doctor refers you
to a physician outside the network, the plan will cover the
cost.
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Fee
for service: You can go to any health care provider after
you meet a deductible. The plan generally covers about 80% of
the expense. One exception is that many plans establish what's
known as "reasonable and customary" charges based
on the going rate in your area. If you exceed those cost parameters,
you pay the difference.
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Medical
savings accounts. Employees make
tax-deductible contributions into an account that can be used
to pay uncovered expenses. Some accounts let subscribers carry
the money over from year to year, while others have a yearly
use-it-or-lose-it provision.
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