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What Type of Health Plan Do I Have?

There are 5 general types of health plans.  Each plan may have a different process or view on paying for new technology or procedures.

  1. Fee-For-Service Indemnity Health Plan (FFS): In traditional FFS plans, the patient has the freedom to choose any doctor or hospital.  The health plan pays for all or part of the cost of the plan based on the contract. Traditional Medicare and Medicaid are FFS plans.

  2. Health Maintenance Organization Health Plan (HMO): In an HMO, the patient must choose a doctor in a predetermined "network" for the health plan to pay all or part of costs.  Access to specialists is through a "gatekeeperprimary care doctor. If the patient goes out-of-network or does not go through the gatekeeper, he or she is responsible for all of the costs.

  3. Point of Service Health Plan (POS): Like an HMO, POS plans have a network and a "gatekeeperprimary care doctor.  However, if the "gatekeeper" doctor makes referrals out-of-network, the plan will pay some of the cost and the patient is responsible for the rest.

  4. Preferred Provider Organization Health Plan (PPO): A POS plan without the necessary referrals for payment from the plan.

  5. High Deductible Health Plan (HDHP): A HDHP can allow for only in-network coverage, similar to an HMO, or allow for out-of-network coverage, similar to a POS or PPO plan. The patient must spend a specified amount (the deductible) before coverage begins.

 

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