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Types of Healthcare Plans

Private Insurance Plans

Sometimes called Commercial Insurance Plans, private plans are the most common in the United States. 58% of Americans have some form of private insurance. Private plans often fall into one of several categories:

  • Health Management Organization (HMO). A HMO is a prepaid health plan. As a member of an HMO you will pay monthly premium in exchange for healthcare coverage for you and your family. The specific coverage (called benefits) varies by plan. In order to manage both the quality of care and the costs, the doctors and hospitals you can visit may be limited. While there is often a copay for visits, your total costs are often less than a fee-for-service plan. HMOs generally require that you choose a primary care physician to oversee all your treatment.
  • Point-of-Service Plans (POS). Some HMO’s have a POS plan. This means that your doctor will likely refer you to someone in the HMO. If the doctor refers you outside of the HMO, you are covered. If you refer yourself outside of the HMO, coverage may be denied or co-insurance required.
  • Preferred Provider Organization (PPO). PPOs work much like HMOs. Like an HMO, you have a network of physicians from which to choose. If you stay within the network, your costs will be lower (though you will likely still have copays). However, if you choose a doctor outside of the PPO, there will still be some coverage.
  • Fee-for-Service. Fee-for-Service plans are often thought of as traditional plans. You purchase the plan, and then you can see any doctor at any facility. There is no network. Fee-for-Service plans are more flexible, but also more expensive.

Public Health Insurance

In the United States, public health insurance programs – often called social insurance or social welfare programs – provide insurance to specific groups of people who would not otherwise have health insurance. In the United States, the primary types of public health insurance are Medicaid and Medicare.

  • Medicaid. Medicaid is a government-funded insurance program designed to provide healthcare to low-income people, especially families with children, the elderly, and the disabled. If you need more information on Medicaid eligibility and funding, contact the Centers for Medicare and Medicaid Services
  • Medicare. Medicare is an insurance plan for people over 65 who have worked for ten or more years in Medicare-covered employment. Individuals receiving Medicare have paid into the insurance program while they worked (similar to a premium), but collect the benefits after they’ve retired. Complete eligibility requirements are available from the Centers for Medicare and Medicaid Services.

Centers for Medicare and Medicaid Services

Presbyterian is pleased to offer a full array of different types of healthcare insurance plans, including an HMO, a PPO, Medicaid, and Medicare.

Making Your Health Plan Benefits Work for You