Compare Types of Health Insurance Plans
Do you know the difference between HMO, PPO, and POS health insurance plans?
Even if you think you're sure you do, it's worth making sure you understand the differences when you're considering what type of coverage best meets your needs.
Please see the chart below for details about these types of plans.
| HMO Health Maintenance Organization |
PPO Preferred Provider Organization |
POS Point of Service |
|
|---|---|---|---|
| Annual Deductible | No, most plans | Yes, most plans | No, for in-network coverage on most plans |
| Set Copayment Amounts | Yes | No | Yes, for in-network coverage |
| Coinsurance | Yes, some plans | Yes | Yes, for out-of-network coverage |
| Out-of-Network Coverage | Emergent care only | Yes | Yes |
| Primary Care Physician Required | Yes | No | Yes |
| Referral Needed | No* | No | No |
| Chiropractic Care or Spinal Manipulation Included | Yes, QHP plans** | Yes | Yes, QHP plans** |
| Premium Cost | $ | $$ | $$$ |
| Individual and Family Coverage | Yes | Yes*** | Yes*** |
| Preventive Care | No charge | No charge (in-network only) | No charge (in-network only) |
| Lifetime Maximum | No | No | No |
| Health Savings Account (HSA) | Yes | Yes | Yes |
| Health Reimbursement Arrangement (HRA) | Yes | Yes | Yes |
| Flexible Spending Account (FSA)**** | Yes | Yes | Yes |
*Optima Health does not require referrals for HMO plans; however other insurance carriers may require a referral for specialist treatment.
**Spinal manipulation is covered under all Affordable Care Act-compliant qualified health plans (QHP).
***Optima Health does not currently offer Individual & Family PPO or POS plans.
****Flexible Spending Accounts are generally offered by an employer and are not specifically tied to a health plan.
Funding Options for Consumer Driven Plans
| HSA Health Savings Account |
FSA Flexible Spending Account |
HRA Health Reimbursement Account |
|
|---|---|---|---|
| Who Contributes? | Employee and/or Employer | Employee | Employee and/or Employer |
| Pre-Tax Contribution? | Yes | Yes | Yes |
| Uses | Qualified medical expenses | Qualified medical expenses | Qualified medical expenses |
| Unused Funds at End of Year | Roll over to next year | Use it or lose it | Given back to employer |
