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PPO - Preferred Provider Organization.
Combines
traditional
service
fees
and
discounts
for
using
a
preferred
doctor
or
hospital
called
'preferred
providers'
or
'network
providers'.
Costs
for
out
of
network
doctors
and
services
are
higher,
and
you'll
pay
a
higher
percentage.
So
if
your
plan
covers
in
network
providers
80/20,
out
of
network
might
be
60/40. |
If you take out this type if insurance, you will be given a health insurance card which you give to your health care provider at the time of your services. Generally the heath care provider bills your insurance company, and the insurance company pays the doctor the negotiated rate.
The
doctor
must
then
write
off
the
difference
between
their
billed
rate
and
the
negotiated
rate.
The
insurance
company
will
pay
their
portion,
and
you
are
responsible
for
the
rest.
If
you
have
not
met
your
deductible,
then
you
pay
100%
of
the
negotiated
rate
until
you
reach
your
deductible
and
out
of
pocket
expenses.
There
are
exceptions
for
certain
preventative
health
services
and
exams
for
mammograms,
prostate
exams,
baby
care
and
immunizations
that
are
paid
for
by
your
insurance
company
annually.
HMO
-
Health
Maintenance
Organization.
With
an
HMO
you
pay
a
monthly
premium
and
a
primary
care
doctor
(a
paid
employee
of
the
HMO)
is
assigned
or
chosen
by
you.
You
are
then
provided
with
comprehensive
health
care
services
and
you
go
to
the
HMO
facilities
when
you
need
them.
HMO's
have
exceptions
for
emergency
care
and
other
medical
situations
that
are
necessary
to
maintain
your
health
or
if
you
are
required
or
need
to
go
outside
the
HMO
for
medical
services
and
procedures.
You
may
be
required
to
pay
a
nominal
co-pay
of
$5
or
$10
for
HMO
doctor
visits
and
$25
for
emergency
room
services.
One
advantage
with HMO’s
is
that
you
do
not
require
any
claim
forms...
all
you
do
is
present
your
health
insurance
card
at
your
doctor
or
hospital
visit.
One
downside
of
HMO's
is
that
typically,
patients
have
to
wait
longer
to
get
an
appointment
with
a
HMO
doctor.
An
HMO
can
also offer
consumers
what
is
known
as a
Point-of-Service
or
"POS"
health
care
plan.
This
means
that
your
primary
doctors
can
refer
you
to
other
providers
outside
the
health
plan
and
the
plan
will
pay
most,
if
not
all,
of
the
coverage.
If
you
refer
yourself
to
doctors
outside
the
plan,
you'll
pay
co-insurance.
Health
Savings
Accounts
(HSA’s)
–
Plans
with
a
high
deductible.
You
are
allowed
to
deposit
tax
deductible
funds
into
a
health
savings
account
tied
to
your
plan
to
cover
medical
costs
that
are
not
covered
under
your
plan
such
as
out
of
pocket
expenses
until
you
reach
your
deductible
limits.
Deductibles
range
from
$1,200
to
$5000
for
single
members
and
$2,400
to
$11,900
for
families.
You
can
deposit
up
to
$3,100
for
single
members
or
$6,250
for
families,
and
if
you
are
over
55
years
of
age,
you
can
deposit
an
additional
$1,000
catch
up
amount.
The
eligible
amounts
you
spend
on
health
care
are
defined
in
the
IRS
code
and
can
be
taken
as a
tax
deduction
on
your
federal
income
tax
reducing
your
income
tax
liability.
Your
state
also
allows
you
to
take
a
state
income
tax
deduction
for
your
HAS
contributions.
Check
with
your
tax
advisor
for
more
information
about
the
deductions. |
