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Health Care Reform:

Health Insurance & Affordable Care Act

4 Types of Health Plans: How They Compare

Point-of-Service Plan (POS)

A POS plan blends features of an HMO with a PPO. With POS plan, you may have:

  • More freedom to choose your health care providers than you would in an HMO
  • Out-of-pocket costs you can control
  • A moderate amount of paperwork if you see out-of-network providers
  • A primary care physician who coordinates your care when you use network providers

What doctors you can see. In-network providers your primary care physician refers you to. You can see out-of-network doctors, but you'll pay more.

What you pay.

  • Premium -- With a POS plan, the premium generally stays low because the deductible is high.
  • Deductible -- You pay a higher deductible if you see an out-of-network provider.
  • Copays or coinsurance -- Your coinsurance is higher, such as 30%, if you see an out-of-network provider.

Paperwork involved. If you go out-of-network, you have to pay your medical bill. Then you submit a claim to your POS plan to pay you back.

High-Deductible Health Plan With Health Savings Account

You may be able to pay less for your insurance with a high-deductible health plan. With an HDHP, you may have:

  • One of these types of health plans: HMO, PPO, or POS
  • Higher out-of-pocket costs than many types of plans, but if you reach the maximum out-of-pocket amount, the plan pays 100% of your care
  • A health savings account (HSA) to help pay for your care because the money you put in savings is not taxed
  • A moderate amount of paperwork
  • To manage your own health care or use a primary care provider, depending on the plan

W hat doctors you can see . This varies depending on the type of plan -- HMO, POS, or PPO

What you pay.

  • Premium: The premium is the lowest for a HDHP compared to other plans.
  • Deductible: The deductible is high -- sometimes more than $3,000 a year for one adult and $6,000 a year for a family. With an HDHP, though, your preventive care is free even if you haven't met the deductible.
  • Copays or coinsurance:  The kind of health plan you have -- HMO, POS, or PPO -- determines which one you pay.

With an HDHP, your out-of-pocket spending is capped. For instance, if you have insurance only for yourself, the most you have to spend in a year is about $6,250. If your insurance plan is for your family, the most you have to pay in a year is about $12,500. The totals include your deductible. If you reach this amount, the HDHP pays 100% of your care.

Paperwork involved.  The amount of paperwork varies, depending on whether you get care from a PPO, HMO, or POS plan. Keep all your receipts so you know when you've met your deductible.

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