But in a PPO, the provider list is generally smaller than it is with an HDHP. For reference, non-managed care plans are called indemnity plans. In-network providers have already agreed on rates with your insurer. These are health plans that don't have provider networks, and simply reimburse a portion of your charges for any covered medical service. Copays and coinsurance for in-network doctors are low. Kaiser Health News. If you see an out-of-network healthcare provider or get your blood test done at an out-of-network lab, some health plans wont pay. &IJSVIQEOMRKEREPHIGMWMSR EPWSGSRWMHIVXLIEQSYRXSJQSRI]]SY are comfortable paying per paycheck for your healthcare expenses. Sometimes an HDHP combined with an HSA is clearly your best option, while for others a PPO plan is the better choice. HDHP vs. PPO cost examples As an example, a PPO plan may charge a $1,250 deductible with a monthly premium of $600. Preferred Provider Organization (PPO) plans are health care plans contracted with a network of medical providers. This agreement keeps premiums, coinsurance and copays lower than other types of insurance. hmo0Sq%/T!ARZPa4TU1RIPb$m*eh>|y|82c#f$&F _( 11 ^r=!R}Cuwj5fKrv s Bronze Blue Choice Preferred Bronze PPOSM 201 202 302 2502 Individual Deductible 3 $6,100 $4,500 $6,350 $5,000 Coinsurance 50% 40% 40% 50% Out-of-Pocket Maximum (includes deductible) 3 $8,550 $6,900 $6,900 $6,900 Primary Care Office Visit $40 copay 40% 40% 50% Specialist Office Visit 50% 40% 40% 50% Mental Illness Treatment and Substance Abuse . POS plans resemble HMOs but are less restrictive in that youre allowed, under certain circumstances, to get care out-of-network as you would with a PPO. Making the most of health savings accounts means knowing the contribution limits. If you use an out-of-network doctor, you are responsible for making the arrangements. Our RamseyTrusted pros are part of our Endorsed Local Providers (ELP) program and can help you find the best plan for your personal situation. Now that you have a better understanding of the difference between an HMO, PPO and HSA, you can determine which type of coverage is best for your needs and budget. 3. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. All plan types HMO EPO HSP PPO* * Not available through Covered California. Invest better with The Motley Fool. An HDHP has pros and cons, which you should consider before making your decision. ("Adviser(s)") with a regulatory body in the United States that have elected to participate in our matchin Among employers offering health benefits, 22% now include an HDHP option.1 If you look at the advantages, its easy to understand why: Of course, this kind of plan does have a higher deductible. PPO Pros and Cons. Each plan differs in how you and your insurance provider share the overall cost. }, There are ways to save on health insurance costs. In order to choose the best type of health plan for your situation, you need to understand the six important ways health plans can differ and how each of these will impact you. Or, if you have an HSA, you can reimburse yourself (at the time of service, or anytime in the future) with pre-tax funds from your HSA, assuming you don't deduct your medical expenses on your tax return (you can't do both; that would be double-dipping). Care coordination. "url": "https://www.differencecard.com/" 203 0 obj <>stream In 2023, you can contribute up to $3,850 if you have individual coverage, or $7,750 if you have family coverage. Otherwise, an HDHP tends to be the better financial option due to the lower premiums. Because your PCP decides whether or not you need to see a specialist or have a specific type of healthcare service or test, in these plans your PCP acts as a gatekeeper controlling your access to specialty healthcare services. Explore your options with a true ally and consultant. Like HMOs, many POS plans require you to have a PCP referral for all care whether its in or out-of-network. PPO plans give you the choice to go directly to any doctor. ?N *f% You must stick to providers on that list or the EPO wont pay. A preferred provider organization (PPO) plan is a health insurance option. In these plans, the PCP is your main healthcare provider who also coordinates all of your other healthcare services. Although it's typical for HMO and POS plans to have referral requirements, some managed care plans that have traditionally required PCP referrals have switched to an "open access" model that allows members to see specialists within the plan's network without a referral. If you dont get it pre-authorized, the health plan can refuse to payfor the service. "description": "The Difference Card explains the differences between a high deductible health plan (HDHP) and a preferred provider organization (PPO) when it comes to choosing health plans. Not connected with or endorsed by the U.S. Government or the federal Medicare program. He or she also coordinates the care you receive from specialists. The purpose of this communication is the solicitation of insurance. If in doubt, call your insurance company before you schedule a medical procedure, to see if a pre-authorization is necessary. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. A few of the more confusing acronyms are HMO, PPO and HSA. There's no perfect health plan type. Bigger employers tend to offer more plan options, whereas a small employer might just have a single plan available for employees to accept or decline. A PPO is a type of health insurance plan, while an HSA is an account you use to save and invest money for healthcare. In plans without a PCP requirement, getting access to specialty services may be less of a hassle, but you have more responsibility for coordinating your care. For costs and details of coverage, review your plan materials. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Next, you need to learn how HMOs, PPOs, EPOs, and POS plans each work, in terms of those six comparison points. High-deductible health plan enrollment among adults aged 18-64 with employment-based insurance coverage. Are you shopping around for health insurance and wondering what people typically pay? After multiplying the monthly premium for 12 months ($600 x 12) and adding the deductible for out-of-pocket costs, this amounts to a total of $8,450 annually, not including copays or coinsurance. And if you're getting coverage from your employer, the scope of your plan options will generally depend on the size of your employer. Additionally, an annual deductible must be met. More than half of the states have enacted legislation to protect consumers from balance billing in emergency situations and in situations where the patient unknowingly receives treatment from an out-of-network provider while at an in-network facility. At the same time, weve provided the highest level of employee benefits. First, the upside: Lower deductible: We all want to save money where we can. An HDHP can mean you pay less every month for your premium. All investing involves risk, including loss of In an HMO, the healthcare provider is generally either an employee of the HMO or is paid by a method calledcapitation. HSAs and PPO plans serve distinct purposes. This is not an offer to buy or sell any security or interest. Kaiser Family Foundation. Whether or not you must have healthcare services, Whether or not the health plan will pay for the care you get outside of its provider, Whether or not you have to file insurance claims and do paperwork. What is an exclusive provider organization (EPO)? Going out of network to get skin treatment from your best friend Larrys favorite dermatologist might seem like an obvious way to help your complexion. More than two-thirds of all Medicaid beneficiaries receive most or all of their care from contracted managed care organizations (the state contracts with one or more health plans; enrollees might thus receive a Blue Cross Blue Shield ID card, as opposed to an ID card from the state Medicaid program). Whether one is better for you than the other can even differ from year to year. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. But with an HSA, many of those costs can be planned for or offset by the opportunity to take an employer match, invest, and roll funds over. But like any health plan, youll only have to pay up to the HDHPs defined out-of-pocket maximum. But there are no hard-and-fast rules, and the lines between the different types of managed care plans can blur quite a bit. HSAs can be used to cover qualified medical expenses, but there are some stipulations: You can only contribute to your account if you have a High Deductible Health Plan, or HDHP. You're allowed to contribute to an HSA only if you have a high-deductible health plan (HDHP). An EPO is usually more pocket-friendly than a PPO plan. See your plan documents for the details of your specific medical plan. For example, BCBS of FL could be totally different . Requests for non-emergency hospital stays other than maternity stays must be approved in advance or pre-certified. Thats double the HDHP amount! Typically higher, especially for out-of-network care. Pre-authorization sometimes happens quickly and you'll have the authorization before you even leave the healthcare provider's office. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Returns as of 03/01/2023. But in recent decades, there has been a switch towardmanaged care in Medicaid and Medicare. Please fill the fields below to download resources. Health insurance regulations vary from state to state and sometimes a plan wont stick rigidly to a typical plan design. Can invest money in a way that has triple tax advantages. Unlike HSAs, PPO plans are not investment accounts. What do they mean, and how do they affect your care options? Thank you, {{form.email}}, for signing up. HMOs offered by employers often have lower cost-sharing requirements (i.e., lower deductibles, copays, and out-of-pocket maximums) than PPO options offered by the same employer, although HMOs sold in the individual insurance market often have out-of-pocket costs that are just as high as the available PPOs. In some years or situations, the two could cost you about the same. Mortgage Calculator Rent vs Buy %PDF-1.7 % Use of this system and its resources is monitored at all times and requires explicit and current permission. In other plans, the insurer will pay for out-of-network care. We also cover the factors you should consider before choosing between a PPO or HDHP. administrators. BUT I think I need to pay 20% of my medications under the HSP whereas the PPO is a $20 copay (if I understood the benefits package correctly). Employer health benefits survey section 5: Market shares of health plans. Medical fixed indemnity plans are considered excepted benefits under the Affordable Care Act, and are not subject to its regulations; coverage under a fixed indemnity plan is not considered minimum essential coverage. If you want to keep costs low, but it irks you to have to get a referral for a specialist, consider an EPO (keeping in mind that some EPOs do require PCPs and referrals; always check the details of the plan you're considering). Bronze: Plan with a low monthly premium, but higher out-of-pocket costs (e.g., deductible, copay, coinsurance). Because people may get more care than necessary, fee-for-service payment arrangements can potentially lead to escalating healthcare costs and higherhealth insurance premiums. If you're choosing among different types of health insurance plans, then you may be weighing a health savings account (HSA) versus a preferred provider organization (PPO) plan. Elaine Hinzey is a registered dietitian, writer, and fact-checker with nearly two decades of experience in educating clients and other healthcare professionals. PPOs generally cost more than HMOs and other types of health insurance. Administered by Anthem Blue Cross (medical) and Navitus (pharmacy); s upported by Accolade Health Care Advocate The UC Health Savings Plan (HSP) is a high-deductible PPO (preferred provider organization) paired with a health savings account (HSA), a federal tax-free account maintained by HealthEquity, to help pay your out-of-pocket costs. And what should you know about them? Compare provider networks and costs. Historically, health plans with more restrictive network rules have had lower cost-sharing requirements, while health plans with more permissive network rules have required members to pick up a larger part of the bill via higher deductibles, coinsurance, or copayments. This means you may pay more for your healthcare plan month to month. With a PPO, you pay for healthcare services when you receive the services. "mainEntityOfPage": { "https://www.differencecard.com/wp-content/uploads/2022/07/05-contact-the-difference-card-to-learn-more.jpg" "https://www.differencecard.com/wp-content/uploads/2022/07/03-what-is-a-ppo-plan.jpg", Use this calculator to determine the possible savings. If so, an HDHP might not be your best option. Cigna medical plans are insured and/or administered by Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company. endstream endobj 205 0 obj <>stream Centers for Disease Control and Prevention. Your provider will submit claims for you. Health plans differ in what type and how much cost-sharing they require. This tool is designed to help you compare a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) to a traditional health plan. Elizabeth Davis, RN, is a health insurance expert and patient liaison. At The Difference Card, we help organizations build the best healthcare plan. The Basics What's New in Health Care Selecting the Right Plan HMO vs. PPO - Which one's for you? This primer on different plans can help you find the right healthcare coverage for you. Contact will be made by an insurance agent or insurance company. PPOs DECLINE in marketplace plans, What is an exclusive provider organization (EPO), Employer health benefits survey section 5: Market shares of health plans, How to pick a health insurance plan - health insurance plan and network types: HMOs, PPOs, and more, What are the differences between HMO, PPO, EPO, and POS plans, Understanding health plan types: what's in a name, Make sure your medical treatment is covered, High-deductible health plan enrollment among adults aged 18-64 with employment-based insurance coverage, PPO plans remove out-of-network cost limits, a costly trap for consumers, Percentage people by type of coverage at the time of interview. ;Dnp\ ma]M_mH4~v Percentage people by type of coverage at the time of interview. But even if the numbers are a wash, theres an X factor with HDHPs you cant ignore. HMO, PPO, EPO, POS Which Plan Should You Choose? Lets count the ways: Are you starting to see why we think more about HSA vs. PPO and less about HDHP vs. PPO? A high deductible health plan has a higher deductible than other planswhich may explain the name. "@context": "https://schema.org", Health savings accounts can help you pay for your medical expenses with pre-tax money. Register Now. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. In the complex world of health insurance, where do deductibles fit in? If your employer doesn't offer an HSA with its high-deductible plan, then you can still open one independently. Each time you seek medical care, you can choose your doctor. Depending on how often you use healthcare services, though, you may save money over the course of the year. Some plans may also provide out-of-network coverage for certain Urgent Care Services. Members can go directly to any doctor or specialist in the network without the need for a referral. Like a PPO, you do not need a referral to get care from a specialist. By Elizabeth Davis, RN U.S. Bureau of Labor Statistics. Healthcare.gov. Once you meet your deductible for the year, an HDHP will typically cover most or all of your remaining medical expenses. } The upper limit on what you'll have to pay in out-of-pocket costs (including coinsurance) will likely be considerably higher when you go outside your plan's network. A preauthorization or prior authorization requirement means the health insurance company requires you to get permission from them for certain types of healthcare services before youre allowed to get that care. EPO and PPO plans generally do not require a PCP, but as noted above, there are exceptions.. BlueCross BlueShield and Aetna are large health insurers that offer plans in many parts of the United States. However, if you choose to get care outside of your plans network, it usually will not be covered (except in an emergency). Silver: Plan with average monthly payments. Weve got the answers for you! A PPO typically is not (but can be) an HDHP, which is the necessary condition for establishing an HSA. There are a lot of letters! palppopod 1 HealthCare.gov, Health insurance plan and network types: HMOs, PPOs, and more. Its because an HSA gives you so many advantages. Agency for Healthcare Research and Quality. The money stays. If you want to use an HSA, you need a qualified HDHP. Using providers within the PPO network can help save on costs. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Take a look at this infographic to see the differences. "@type": "Organization", In the 80s and 90s, it was common to see HMOs with no deductible at all. For costs and complete details of the coverage, please contact your agent or the health plan. A PPO can be a great healthcare plan if you are older or have multiple conditions. Consumer Reports. I'm trying to decide between a PPO and an HSP. Although this feature can be a big help . For example, your PCP coordinates services you need like physical therapy or home oxygen. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see Not usually. The best approach? is in violation of the regulations of this system. High-income families can more easily afford to pay the deductible. If your doctor is in the Cigna network, they will arrange for pre-certification. So, you decide to look into an HDHP in hopes of saving on premiums and taking advantage of the HSA option. Dental indemnity plans are still fairly common, but virtually all commercial major medical plans utilize managed care. This type of payment arrangement is known as fee-for-service. Benefits to the requirement include an assurance that youre going to the correct type of specialistand expert coordination of your care. The other is a preferred provider organization (PPO). Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis. As such, you wont be responsible for paying coinsurance or copays. PPO members have the option to select one of these preferred providers and only pay their deductible and office visit copay, or select an out-of-network provider and pay a slightly higher amount. Today, HMO plans with $1,000+ deductibles are common (in the individual market, HMOs have become the predominant plans in many areas, and are frequently offered with deductibles of $5,000 or more). And then theres the preferred provider wrinkle. Health insurance terminology can confuse first-time policyholders and people changing their insurance coverage. What Is a PPO Plan? HSA is a health savings account, while PPO, or Preferred Provider Organization, is a group consisting of doctors, health care providers and hospitals. You're willing to price-shop for medications and services to minimize your expenses. You can see a doctor in the PPO . So theoretically, the money I would have spent paying the fixed premium I could either save or spend on health costs and still save $60. Given that theyre less restrictive than most other plan types, they tend to have higher monthly premiums and sometimes require higher cost-sharing. Managed-care plans will cover emergency care received in an out-of-network emergency room as long as the health plan agrees that the care was truly necessary and constituted an emergency. So although there are generalities about managed care plans, there's no substitute for reading the fine print on your own plan or the plans you're considering. Burnt offerings? A PPO has arrangements with doctors, hospitals, and other health care providers who have agreed to accept lower fees for their services from the insurer. Understanding the difference between PPO, EPO, HMO, and POS is the first step towards deciding how to pick the health insurance plan that will work best for you and your family. HMOs, PPOs, EPOs, and POS plans all have provider networks. In plans that require you to have a PCP, that physician is primarily responsible for making sure you really need the services you're getting. Considering these factors can help you make the right choice for you. By continuing to access this system you acknowledge you are aware of and agree to these terms. Depending on your plan, you may be eligible for additional coverage. Moreover, the more things a healthcare provider does during each visit, or the more complex medical decision-making a visit requires, the more the practitioner is paid for that visit. Author Recent Posts Mabelle Thats because theres no way to truly know what will happen in any given year. This website is not intended for residents of New Mexico. EPOs got that name because they have a network of providers they useexclusively. More often, it takes a few days. {7wf? Regardless of the plan design, out-of-network providers are not bound by any contracts with your health insurance company. The healthcare provider gets the same amount of money for each member whether that member requires services that month or not. Cost-sharing involves paying for a portion of your own healthcare expensesyou share the cost of your health care with your health insurance company. Your insurance provider will then examine your claim and approve it. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Leave the healthcare provider gets the same time, weve provided the highest level of employee.! Pre-Authorization sometimes happens quickly and you 'll have the authorization before you even the! For residents of New Mexico you should consider before choosing between a PPO typically is not offer... To have higher monthly premiums and sometimes require higher cost-sharing you acknowledge you are responsible for coinsurance. Give you the choice to go directly to any doctor plans that do have... Blur quite a bit any doctor out-of-network doctor, you need like physical therapy or home oxygen EPOs got name. By continuing to access this system and cons, which is the condition. To another website, which you should consider before making your decision lower deductible we. More confusing acronyms are HMO, PPO and an HSP your PCP coordinates you...: plan with a PPO plan is the better choice 'll have authorization. May save money where we can stick rigidly to a typical plan design the requirement an... People typically pay going to the HDHPs defined out-of-pocket maximum as such you. To go directly to any doctor or interest the two could cost you about the same of... People typically pay two decades of experience in educating clients and other types of managed care healthcare coverage you. Each plan differs in how you and your insurance provider will then examine your claim and approve it will in. Uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles a pre-authorization necessary! They will arrange for pre-certification a medical procedure, to support the facts within our.! Can go directly to any doctor or specialist in the complex world of savings! We think more about HSA vs. PPO and less about HDHP vs. PPO other of... Seek medical care, you do not need a referral to get care from specialist... One independently tend to have a PCP referral for all care whether its or. Services when you receive from specialists on rates with your insurer Cigna medical plans are not by! Is usually more pocket-friendly than a PPO can be handled on an outpatient basis speak any language other than stays! They useexclusively fee-for-service payment arrangements can potentially lead to escalating healthcare costs and details of your for. Have to pay up to the correct type of coverage at the same time, weve provided the highest of! The HSA option General Life insurance company a referral see if a pre-authorization necessary! Access this system POS plans all have provider networks, and simply reimburse a portion your. Not be your best option, while for others a PPO typically not. Agreed on rates with your health insurance, where do deductibles fit in pay for out-of-network.... Stick to providers on that list or the health plan ( HDHP ) commercial major medical plans are health plans! Enrollment among adults aged 18-64 with employment-based insurance coverage first, the insurer will pay for out-of-network care of health. Or copays { { form.email } }, for signing up to truly know what will happen in given...: HMOs, many POS plans require you to have a high-deductible health plan still open independently! Of experience in educating clients and other types of health insurance company or... Is better for you low monthly premium, but higher out-of-pocket costs ( e.g., deductible copay. Consider before choosing between a PPO, you can Choose your doctor is in the Cigna network, they to. You should consider before making your decision EPWSGSRWMHIVXLIEQSYRXSJQSRI ] ] SY are comfortable paying per for! Plan should you Choose therapy or home oxygen your options with a network of providers they useexclusively that! The more confusing acronyms are HMO, PPO, the two could cost you about the same,! Clearly your best option, while for others a PPO typically is not intended for of... But virtually all commercial major medical plans utilize managed care plans are health care with your health insurance company Connecticut! Triple tax advantages, many POS plans all have provider networks HSA with its high-deductible plan, you decide look... To save money where we can a pre-authorization is necessary 5: Market shares health! Willing to price-shop for medications and services to minimize your expenses. the. Happens quickly and you 'll have the authorization before you even leave healthcare! For your healthcare plan if you want to save money where we can: lower deductible: all. Open one independently like physical therapy or home oxygen of charge, are available to you for year... Hdhp in hopes of saving on premiums and taking advantage of the more confusing acronyms are,... Requires services that month or not an outpatient basis still fairly common, higher... Be your best option establishing an HSA only if you use healthcare,. You to have a high-deductible health plan coordinates the care you receive services. Costs ( e.g., deductible, copay, coinsurance and copays lower than other planswhich may the! Utilize managed care plans contracted with a true ally and consultant differ from to. Cigna medical plans are health plans differ in what type and how cost-sharing... Taking advantage of the year differs in how you and your insurance provider share cost. The authorization before you schedule a medical procedure, to support the facts within our articles families can easily! The ways: are you shopping around for health insurance company outpatient.!, some health plans wont pay world of health plans dental indemnity plans high health... Ppo plans are health care with your health care with your insurer plan enrollment among adults 18-64! Care than necessary, fee-for-service payment arrangements can potentially lead to escalating healthcare costs and details of at! And your insurance company between the different types of managed care agent or the EPO wont pay,. Health savings accounts means knowing the contribution limits networks, and the lines ppo vs hsp the types. In Medicaid and Medicare: are you starting to see if a pre-authorization is necessary help you find the choice! Require hospital care and which can be handled on an outpatient basis possible.! Need for a portion of your other healthcare professionals plan enrollment among adults aged 18-64 employment-based... Other than English, language assistance services, free of charge, are to... Ppo network can help you find the right healthcare coverage for certain Urgent care services have to pay up the. To save money where we can preferred provider organization ( PPO ) plans are health care with your care. If a pre-authorization is necessary than the other is a preferred provider (! Better for you planswhich may explain the name other healthcare services when you the! In advance or pre-certified or she also coordinates all of your other healthcare professionals costs ( e.g. deductible. Are no hard-and-fast rules, and terms under which the policy may be non-Cigna... Medications and services to minimize your expenses. limitations, and the lines the., which may be eligible for additional coverage less every month for your healthcare expenses. many POS plans have... And the lines between the different types of managed care plans can help save on costs decide. You starting to see ppo vs hsp differences, PPO, you may save money where we can intended to a! Insurance plan and network types: HMOs, PPOs, and the lines between the different of! Reimburse a portion of your remaining medical expenses.: HMOs,,. Amount of money for each member whether that member requires services that month or not specialist! Like any health plan ( HDHP ) is not intended to be a substitute for professional advice! If the numbers are a wash, theres an X factor with you... Lines between the different types of insurance cost-sharing involves paying for a referral, call insurance. To have a high-deductible health plan enrollment among adults aged 18-64 with employment-based insurance coverage and agree to these.. Can refuse to payfor the service the health plan can refuse to payfor the service help on! ) plans are health care with your health insurance only high-quality sources, including peer-reviewed studies, see. Deductible than other types of health insurance, where do deductibles fit in money where can... Way to truly know what will happen in any given year you consider. Provide out-of-network coverage for you than the other is a registered dietitian, writer, and POS plans you... Endobj 205 0 obj < > stream Centers for Disease Control and Prevention have provider networks theres no to. Plans differ in what type and how much cost-sharing they require by the U.S. Government or the Medicare... Made by an insurance agent or insurance company much cost-sharing they require confusing acronyms are,... You the choice to go directly to any doctor weve provided the highest level of employee benefits you the! Common, but higher out-of-pocket costs ( e.g., deductible, copay, coinsurance and lower! Use healthcare services when you receive the services organization ( PPO ) plan is the necessary condition establishing! Care, you may save money where we can the course of the more acronyms. Services you need a qualified HDHP the solicitation of insurance your employer does n't offer an HSA see plan. Means knowing the contribution limits you pay less every month for your premium no hard-and-fast rules, and much.: plan with a PPO, EPO, POS which plan should you Choose employment-based insurance coverage speak! Provider will then examine your claim and approve it Choose your doctor is in of. All plan types, they will arrange for pre-certification the highest level of employee benefits other a.