You want health coverage, but want to know what your options are? You know your options, but want to know the difference among the various plans? If you answered “yes” to either of this questions, the six health plan definitions below will be of significant help as you decide upon health care alternatives.
1. COBRA: COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It’s a policy that gives you the option to continue your current healthcare plan (i.e. the health insurance plan provided by your former employer). Here’s the catch: With COBRA, you now pay for 100% of the cost! You have 60 days after your departure to “elect” COBRA coverage. COBRA coverage lasts for up to 18 months.
2. Fee for Service: A health insurance plan where you pay a fixed percentage of the cost for any service received. As an example, you pay 25% of the cost for any doctor’s visit, hospital stay, or prescription, and the insurance company pays the remaining 75%. Fee for service health insurance plans have largely been replaced by managed care plans in the United States. Fee for service health insurance is also referred to as indemnity health insurance plans.
3. High-Risk Pools: Health insurance provided by states that cover individuals who have been denied health insurance because of a pre-existing medical condition. High-risk pools generally take the form of an HMO or PPO, and premiums are capped at a certain level. Over 30 states offer high risk pools. High-risk pools can be tricky, because many states offering these programs use different names to describe them.
4. Managed Care: Managed care “plans” (also referred to as “organizations,” insurance,” or “companies”) are the most common type of health coverage in the United States. There are actually three health plan definitions included within Managed Care: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. Managed care plans employ the concept of a network, which refers to a group of doctors, hospitals, and other healthcare providers. When insured under a managed care plan you’ll be referred to as a “member” of the plan. As a member, you are entitled to seek medical service with doctors and facilities that are part of the managed care network. If you require care outside of the network, you will pay a premium for this service. In addition, managed care companies may require prior approval for certain types of medical care (e.g. seeing a specialist or undergoing expensive procedures). In doing so, these groups are able to “manage” the care that patients receive, thereby reducing overall costs. Collectively, managed care plans currently account for the vast majority of private health insurance in the United States.
- Health Maintenance Organization (HMO): A type of managed care insurance plan. Services are provided by doctors who are employed by, or “contracted with,” the HMO. In contrast with other managed care plans, HMOs require that you seek a referral from a primary care physician prior to seeing a specialist. In addition, HMOs do not provide insurance coverage for you to see out-of-network doctors, meaning that if you need to see a doctor who is not contracted with the HMO, you will have to pay 100% of the cost. The HMO network of doctors will likely be large enough to have a doctor that meets your needs. Because of these limitations, HMOs are typically the most affordable healthcare option.
- Point of Service (POS): A type of managed care insurance plan that combines some the features of an HMO and a PPO. A point of service plan enables you to see out-of-network doctors and receive some insurance coverage. Think of a point of service plan as having more flexibility than an HMO, but less than a PPO.
- Preferred Provider Organization (PPO): A type of managed care insurance plan offering the most flexibility. As a member of a PPO, you can see in-network and out-of-network doctors, and may seek the care of a specialist without the referral of a primary care physician.
5. Self Insurance: Going without health insurance. Technically, self insurance refers to setting aside an appropriate amount of money to pay for both expected and unexpected medical care.
6. Temporary Health Insurance: Short-term health insurance plans that last anywhere from one month to twelve months in duration. Temporary health insurance plans offer limited healthcare coverage relative to traditional health insurance plans, and the insurance companies that provide these policies have the option to prevent you from renewing the plan at expiration. Because of their limited scope and unfavorable renewal provisions, temporary plans are typically priced at a discount compared to traditional healthcare plans. Temporary health insurance plans are also referred to as “short-term policies.”