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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) continued...

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

What you pay:

  • Premium: This is the cost you pay each month for insurance.
  • Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services.You may pay a higher deductible if you see an out-of-network provider.
  • Copays or coinsurance: You will pay either a copay, such as $15, when you get care or coinsurance, which is a percent of the charges for care.  Copayments and coinsurance are higher when you use an out-of-network doctor.


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 or Without a 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. The money you put in an HSA is not taxed and can be used tax-free on eligible medical expenses.


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

What you pay.

  • Premium: An HDHP has the lowest premium compared to other plans.
  • Deductible: The deductible is high – in 2015, deductibles for individual health plans range between $1,300 and $6,450 for one person or between $2,600 and $12,900 for a family. Like with HMOs and PPOs, your preventive care is free even if you haven't met the deductible.
  • Copays or coinsurance:  You must review your plans benefits carefully to learn what you will pay when you go for medical care.

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 $6,450, not including premiums. If our insurance plan is for your family, the most you have to pay in a year is about $12,900 without premiums. The totals include your deductible. If you reach this amount, the plan 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.

WebMD Medical Reference

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