HMO (Health Maintenance Organization) Plan

• As one of three plans under the managed-care program, an HMO (Health Maintenance Organization) plan is the most restrictive, yet provides the insured with the most coverage from the insurer. An HMO member is assigned a primary care physician (PCP) from a network of contracted doctors in their geographical area. The PCP is known as the "gatekeeper" who coordinates all of the patient's medical needs. The member will have little or no co-pays when he receives medical care from his PCP or when his doctor refers him to another physician in or out of network. Without a referral, the member is liable to pay higher out-of-pocket costs for medical treatment by another doctor in the network, and possibly the entire bill if the care was done by a non-network physician.
  
  

PPO (Preferred Provider Organization) Plan

• Although it operates under the managed-care program, a PPO (Preferred Provider Organization) plan doesn't have the restrictions of the other two plans. A PPO doesn't require a PCP and it allows you to receive health care from any physician in or out of network. You also don't need a referral to see a doctor of your choice. However, the plan encourages its PPO members to retain their medical services in-network by providing financial incentives such as lower out-of-pocket expenses (smaller deductible and co-pay, higher reimbursements). If a PPO member decides to receive non-network care, he may have to pay up to 50 percent of his medical bill.
  
  

POS (Point of Service) Plan

• A POS (Point of Sale) plan is a blend of the two other managed-care plans. Like an HMO, a POS has an assigned network of doctors for its members and, although it is not required, it is strongly encouraged that members choose a PCP. POS members receive higher coverage benefits when using their PCP for medical attention and for referrals to other doctors. Like a PPO, a POS allows you to see any doctor in or out of network for medical care. Choosing to do so without being referred will lead to higher out-of-pocket expenses. This plan is a popular choice among the three because it provides the flexibility to choose any doctor for care while maintaining a cost-effective approach.
  
  

Indemnity Health Plans

• Indemnity health plans are often referred to as a "traditional" health package because it is one of the first health plans offered. These plans operate by reimbursing the insured after they file a claim for the services received. There are three options available under this plan. Two are similar reimbursement options, with one paying 100 percent of the insured's claim. The other pays a percentage, about 80 percent, of the total claim, with the insured being responsible for the remaining portion. The third option pays the insured a specific amount a day for services received, up to a maximum number of days. These plans provide the insured the authority to receive health care from any doctor regardless of location. However, it is an expensive plan with insurers, and physicians possibly requiring the insured to pay the entire bill up front before getting reimbursed.
  
  

Medicare/Medicaid

• These two government-sponsored programs entitled to all U.S. citizens as long as they meet certain requirements. The Medicaid plan benefits the poor or disabled who meet the guidelines for income levels and medical conditions set by the state the person lives in. Medicare is a plan designed for seniors over the age of 65. It is also available to seniors younger than 65 who possess a disability. There are two major parts of Medicare (Part A and Part B) that are important to the functions of this plan. Part A is a free option that covers hospital and hospice care. Part B, which is paid by monthly premiums, provides coverage for physician visits and outpatient care and services that Part A may not cover.