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Different Types of Health Insurance Explained
There are several different types of insurance plans. With all the different types of health insurance available, it’s no wonder there is confusion about how it all works. This is a very thorough but simple explanation of five basic types of health insurance available to you. With a better understanding of the different types available, you should be able to make a more educated decision as to which is the best for your personal family situation.

An indemnity plan is also called a fee-for-service program. You are allowed to choose whatever doctor, hospital, or health care facility of your choice. Your insurance company will pay a certain amount of the costs incurred according to a predetermined fee schedule. The fee schedule simply states at what time the company will pay for certain services, like ambulance services or certain tests. There is a monthly fee, called a premium, to be paid. Most fee for service plans include a high deductible that must be reached before the company will pick up payments. For these reasons, a fee-for-service plan is the most expensive type of insurance to be had.

Almost all fee-for-service plans have a “cap” on how much you will have to pay each year. After you reach this “cap” insurance will pick up expenses that are covered completely. Each policy is different, and the out of pocket expense could be $1,000 or up to $5,000 and does not include your monthly premium.

There are two categories of fee-for-service insurance which are basic and major medical. Basic coverage will pay for things like your hospital room, certain lab tests and x-rays, and any prescription medication. Major medical insurance will pick up when your basic insurance has reached its limit. Major medical coverage is used in the case of any long-term illnesses.

An HMO is a health maintenance organization, and has very strict rules. This type of plan is a type of managed care plan. When you are on an HMO plan, you must choose a doctor that is within the HMO network of physicians. This will be called the primary care physician, and this is the person in charge of referring you to specialists. You don’t have to pay for your services up front, and there is usually a very small co-payment you have to pay, if any.

Because there is a small monthly fee for everyone it limits covered expenses on the plan. There are certain procedures and tests that must be approved by your carrier in order to be covered and it can take a significant amount of time to see a specialist. This is especially true for those with pre-existing conditions.

You must also use hospitals and health care facilities that are in the HMO network. If you go to a health care facility that isn’t in the network your expenses will not be covered. Fortunately there are a lot of health care facilities throughout the country to choose from.

A PPO or preferred provider organization is a type of health care plan that also uses a network of doctors like an HMO. The major difference in PPOs and HMOs is with a PPO you don’t have to choose your primary care physician. This means you don’t have to have referrals to see specialists. This eliminates excessive wait periods to get the care you need. You will be required to pay a higher co-payment if you see a doctor outside of the network of providers.

The PPO is like an indemnity plan as well. You must meet a deductible before your coverage kicks in. You can go to doctors or health care facilities that are out of network if you pay larger co-pays. A PPO will cost more than an HMO but less than a fee-for-service plan. If a plan is more flexible it is going to be more expensive.

A POS or point of service plan is a type of plan that combines attributes of a PPO and an HMO. A POS has no deductible to be met and very small co-payments like an HMO. It uses a network of doctors and a primary care physician must be chosen. This means you will have to have a referral in order to see a specialist.

Like a PPO, there is limited coverage available for out-of-network doctors. It is limited in that the coverage is significantly less when an out-of-network doctor is used and a deductible and co-payment are required. Also like a PPO, when a predetermined out of pocket amount has been reached insurance will pick up payments. With most POS plans, if the out-of-pocket deductible is not met within the year it does not carry over. However there are some that offer carry over benefits.

Finally, an HSA is a health savings account. This is different from the other plans because it is a type of health care plan especially for retirees. It is a tax free savings account contributed to by the individual under the age of 65 with a qualifying health plan. Contributions can also come from family members and employers. The HSA can cover the individual or can be a family plan. The money that goes into the account can only be used for medical services.

If the plan is for the individual only, the annual deductible is $1,000 to $5,000. Family plans can have a deductible anywhere from $2,000 to $10,000. There is a cap on all out of pocket expenses, as well. Preventive care is not subject to the deductible, nor is long term care. The individual may contribute 100% of the deductible, with an annual maximum being $2,600 for a single person and $5,150 for a family plan. In the event of the death of the individual, the plan will be carried over to the spouse with no taxes applied.

There are many different rules and regulations to health insurance, making it confusing to the everyday person. Hopefully this overview helped to better your understanding so you can make a choice of which insurance is right for you.