Group Health Plan Comparison
At many companies, employees have a choice of plans. To help you choose, here's an overview of three well-known plan types.| Health Maintenance Organization (HMO) | Preferred Provider Organization (PPO) | High Deductible Health Plan (HDHP) | |
|---|---|---|---|
| What is it? | With an HMO, you select a personal doctor – sometimes called a Primary Care Physician, or "PCP" – who is in the plan's network. Your personal doctor tends to most of your health needs and refers you to a specialist in the network if necessary. | With this plan, you get coverage for doctors in AND out of the plan's network. You pay less when you go to doctors, hospitals, and other providers in the plan's network. | This specially designed plan has one deductible that combines healthcare and prescription drug expenses. An HDHP is usually a Preferred Provider Organization (PPO) plan, but it could also be a HMO or Point of Service plan. |
| Do I have copayments? | Yes Copayments depend on the plan you choose and the type of service you receive. For example, you might pay in the range of $10 to $25 for a primary care doctor, $20 to $50 for a specialist, and $100 to $300 per day for hospitalization. |
It depends Some PPO plans have copayments, others require you to pay a percentage of your costs, and some have both. For plans with copayments, the amount usually ranges from $10 to $25 for a primary care doctor, $20 to $50 for a specialist, and $100 to $300 per day for hospitalization. |
It depends Generally you pay all expenses until you meet the deductible, so you don’t have copayments. However, some plans cover certain preventive services – at 100% or for a copayment – even before you meet your deductible. |
| Is there a deductible? | It depends Some HMO plans don't have a deductible – you pay a copayment, and your plan takes care of the rest. But others have a deductible for certain expenses, like hospital stays, outpatient surgeries, and other similar services. |
Usually The deductible for in-network providers can range from $250 to $5,000 per person ... or $500 to $10,000 for a family. |
Yes In 2007, the minimum deductible set by the Internal Revenue Service (IRS) is $1,100 for single coverage and $2,200 for family coverage. The dedutible includes medical and pharmacy expenses in this plan. |
| Can I get a healthcare spending account? | FSA In limited cases, your employer may offer a Flexible Spending Account (FSA). An FSA allows you to set aside tax-free dollars for copayments, prescription drug costs, and other items on your employer's approved list. FSAs are not offered with HumanaOne or Medicare plans. |
FSA and PCA Your employer may offer a Flexible Spending Account (FSA) that you put money into, a Personal Care Account (PCA) your employer puts money into, or both. FSAs and PCAs are not offered with HumanaOne or Medicare plans. |
HSA and limited FSA With a HDHP plan, you can put money in a Health Savings Account (HSA). Employees with an HDHP and HSA with Humana may also have the option of putting money in a "limited" Flexible Spending Account (FSA) – an account that's just for dental, vision, and preventive care expenses. FSAs are not offered with HumanaOne or Medicare plans. |
| Any drawbacks? | Limited provider choices HMO plans usually cover only doctors, hospitals, and other providers in the plan’s network – unless it’s an emergency. And your PCP handles most of your care, so you’ll need a referral to see a specialist. |
Out-of-network charges PPO plans allow you to go to any provider, but you’ll pay a larger share of the costs if you choose a doctor, hospital, or facility that isn’t in the plan’s network ... plus those costs typically don’t count toward your in-network deductible. |
Higher, integrated deductible This kind of plan tends to have a higher deductible than a traditional PPO plan and you could have higher out-of-pocket costs. |