Types of Insurance
PRIVATE HEALTH INSURANCE PLANS
Many people get health insurance in one of two ways. Individuals can purchase a plan for themselves directly from a private health insurance company, such as Presbyterian Health Plan, or they may obtain a health plan offered by their employer who purchases insurance on their behalf. These plans fall into one of four plan types: HMO, PPO, POS or Fee-for-Service.
Health Management Organization (HMO): With an HMO, you will pay a monthly premium in exchange for health coverage. HMOs often require that you choose a primary care physician (PCP) to oversee your treatment and health needs. You also have a specific network of providers from which to obtain your care.
Preferred Provider Organization (PPO): Like an HMO, you have a network of providers from which to choose. If you get your care with providers in the network, your costs will be lower (though you will likely still have copays). However, if you choose a provider outside of the PPO, you will still receive a percentage of coverage, but the cost will be higher.
Point-of-Service Plans (POS): Some HMOs offer a POS plan. If your provider refers you outside of the HMO network, your costs are covered. If you refer yourself outside of the HMO network, your coverage may be denied or coinsurance required.
Fee-for-Service: Fee-for-Service plans are often thought of as traditional plans. You can purchase the plan, and then you can see any doctor at any facility. There is no network. As a result, Fee-for-Service plans are more flexible, but also tend to be more expensive.
Many companies offer insurance packages to their employees as part of their compensation. This means that the employer is usually paying part of the cost for the plan.
Medicaid is a government-funded program that offers health insurance to low-income individuals, including families with children, individuals with disabilities and the elderly.
Medicare is a federal health insurance program that offers hospital and medical coverage. To receive Medicare, you must meet specific criteria and enroll. In general, you are eligible for Medicare if you are 65 years of age or older, are under 65 years of age with certain disabilities or end-stage renal disease, and you are a citizen or permanent resident of the United States.