Some HMO plans also offer out-of-network benefits where the subscriber may seek medical care outside the HMO network. Generally, a HMO plan with an out-of-network option will have a higher premium and using the out-of-network benefit requires significantly higher co-pays and/or deductibles.
PPO- The Preferred Provider Organization is simply a network of doctors and hospitals that have contracted with an insurer to provide care to its subscribers. As a PPO member you must use physicians and hospitals that are in the PPO network however you do not have to select a primary care physician and you generally do not need referrals to see specialists as long as they are part of the PPO network. Some PPO plans require that a deductible be met before benefits are paid however it is more common to simply have co-pays for various physician, lab and hospital services.
Indemnity Plans- The Indemnity plan, sometimes called a "traditional plan," generally provides the most freedom of choice in doctors and hospitals for the subscriber. However, unlike the HMO, a deductible will apply before benefits are paid and very often there will be an 80/20 cost sharing in addition to the deductible. This means the subscriber's responsibility could be the deductible plus 20% of the doctor or facility's bill. Most policies have a maximum out-of-pocket limit after which the insurance company pays 100%. As always it is important to ask questions and make sure you understand potential out-of-pocket medical costs before purchasing any health insurance policy. If a subscriber is willing to pay smaller medical bills out-of-pocket and accept a higher deductible, significant premium savings can be realized. |