Since contracting discounts from a network of providers is one of the primary ways an HMO maintains cost effectiveness, treatment received outside the network is usually not covered. While an HMO is more restrictive than other plans, doctor visits and health care can be simple, easy and reliable. Home About News. English Spanish.
Related Links Visit these links for more information on related topics. If your plan is designed with copays only, this will work just like the HMO plans do. You pay a set amount at the time of service. However, if you have a deductible with coinsurance, you will pay a certain percentage for services until your deductible is met. After your deductible is met, you may still need to make a copayment at the time of service.
The range of covered services varies from one plan to the next. If a plan is offered on any Affordable Care Act ACA marketplace, it is required to cover preventive care such as checkups, physicals, or immunizations as well as emergency services and maternity care. These services are known as the 10 essential benefits. With an HMO, patients do not need to file a claim because the insurance company pays the healthcare provider directly. Under a PPO, however, a patient must sometimes first pay out-of-network providers for any services received and then file a claim for reimbursement from their insurance company.
Can receive at least limited coverage with an out-of-network provider. Can receive at least limited coverage for prescriptions at any pharmacy. Provider or policyholder must file a claim to receive payment of benefits. Today, there are four different types of HMOs: Once HMOs were born, insurance companies saw an opportunity to provide patients with more flexibility while giving themselves better control over medical costs.
Hence, PPOs were introduced. PPOs rose to popularity among large corporations with many offices spread throughout the country, as a comprehensive PPO plan allows for greater geographical flexibility among the many employees.
There are some additional insurance plans that operate in a similar fashion. An EPO, or Exclusive Provider Organization , functions as an HMO but does not require all care to be funneled through a primary care physician, and no referrals are needed to see a specialist.
Just like an HMO, coverage is limited to only doctors within a network. And like a PPO, a POS allows for coverage outside of the network but generally with a referral from the primary care physician. A Fee for Service FFS plan, sometimes called an indemnity plan , allows for the most freedom and flexibility, but also comes with the highest price tag. FFS patients can choose physicians and specialists at will but face high out-of-pocket expenses and are not always covered for preventive services.
This type of plan may require you to pay for all services and then submit a claim to your insurance company for reimbursement. The tradeoff is a lower monthly premium. An HSA collects non-taxed contributions from your paycheck and uses that fund to pay for out-of-pocket health costs such as copays or coinsurance.
References: 1. Accessed on February 10, January Each type of insurance plan or coverage program has rules that you must follow to get care.
Many people buy an insurance plan on their own or through their employer. Other people get health care through public programs. This tells you about common kinds of health coverage. Many Californians have health care benefits supported or administered by a federal, state, or local government program. Public supported health care coverage programs include:. In addition to the full-coverage programs listed here, there are also some programs that provide coverage for specific health conditions or needs.
See Limited-Scope Public Programs. Some Californians have a fee-for-service plan, but that is less common. High-deductible plans have lower premiums but higher deductibles, compared to typical health plans.
Some group plans are self-insured and have special rules. If you buy health insurance on your own, not through a job or union, you have individual coverage.
Under health care reform changes in , individual coverage has more benefits and rights and is similare to group coverage in many respects. This website is not intended for residents of New Mexico. Selecting these links will take you away from Cigna. Cigna may not control the content or links of non-Cigna websites.
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