Group Health Plan Comparison
At many companies, employees have a choice of plans. Here's a 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, members select a personal doctor – sometimes called a Primary Care Physician, or "PCP" – who is in the plan's network. This personal doctor tends to most of the member's health needs and provides a referral to a specialist in the network if necessary. This plan could include a separate pharmacy benefit. |
With this plan, members get coverage for doctors in AND out of the plan's network. They pay less for doctors, hospitals, and other providers in the plan's network. This plan could include a separate pharmacy benefit. |
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 members have copayments? | Yes Copayments depend on the plan design and the type of service the member receives. For example, members 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 members to pay a percentage of their 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, members pay all expenses until they meet the deductible. However, some plans cover certain preventive services – at 100% or for a copayment – even before the deductible is met. |
| Is there a deductible? | It depends Some HMO plans don't have a deductible – the member pays a copayment, and the 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 members get a healthcare spending account? | Typically no Spending accounts are not typically offered with Humana's standard HMO plans, unless the employer is also offering one of Humana's consumer-driven plans. |
FSA and PCA With certain PPO plans, members can have a Flexible Spending Account (FSA) that they put money into, a Personal Care Account (PCA) the 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, members can put money in a Health Savings Account (HSA). Employers who offer a Humana HSA and HDHP may also offer 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 the PCP handles most care, so members need a referral to see a specialist. |
Out-of-network charges PPO plans allow members to go to any provider, but they pay a larger share of the costs if they choose a doctor, hospital, or facility that isn’t in the plan’s network ... plus those costs typically don’t count toward the in-network deductible. |
Higher, integrated deductible This kind of plan tends to have a higher deductible than a traditional PPO plan and some members could have higher out-of-pocket costs. |