Fee for service
For many years the fee for service plan was very popular and widely used type of health insurance. The insured pays a monthly fee. A deductible is applied to the cost of the services. Some services related to healthy living or emergency services may be exempted from the deductible. Once the deductible has been met the insured and the insurance company share the cost of services. For most companies the split may be 80 / 20 or 70 / 30. The company pays eighty or seventy percent, the insured pays twenty or thirty percent. There will be a cap on the total amount of money the insurance company will pay in a lifetime.
Health Maintenance Organization ( HMO )
HMOs have become increasingly more common in the last decade. Again, the insured pays a premium which makes him / her a member of the HMO. As a member of the group the member is entitled to visit any of the doctors who are part of the group. These doctors may all work together in an HMO facility or may work in individual clinics as part of a group of doctors under contract to the HMO. Members may have to pay what is called co - pay when they visit the doctor. No paperwork is necessary to validate the claims of an HMO member; however, members may wait longer for non - emergency appointments than they would with a fee for service insurance program. An HMO generally requires its members to have a primary care physician who then refers the member to a specialist if needed.
Preferred Provide Organizations ( PPO )
The PPO, a blend of the fee for service model and the HMO model, is a fast growing sector of health insurance. As with an HMO there is a network of doctors from which the insured chooses his / her physician. This physician is responsible for designating the need for specialized care. A co - payment will be required when an office or hospital visit is made. There will also be a deductible and medical expenses will be divided at an agreed upon scale between the insured and the insurance company operating the PPO. A person may choose to use a doctor who is outside of the network. Expenses incurred for medical care outside the network will make the patient’s share higher.
Please collect as many quotes as possible in order to compare services and rates. This is a free way to learn a lot about all of your options.