Major Medical: With this plan, you would be the insurance would cover bills and you would be responsible for the remaining 20%. You have the freedom to go to any hospital or doctor’s office for treatment, pay the bill yourself to the care provider, and then be reimbursed for 80% of it by the insurance company. Or you have the option to sign a release instructing the insurance company to pay the care provider the 80% directly and then you would pay the remaining 20%.
An HMO, Health Maintenance Organization is a type of insurance that focuses mainly on long-term care and would generally be less expensive. Costs are kept down by limiting the choices of physicians only within a network and not covering unnecessary services. Each patient would have a primary physician and they would coordinate care if it was required.
A PPO, a Preferred Provider Organization works in a similar way to an HMO where there is a network of physicians, however, the insured is not limited to this network and can see any doctor they choose. In the instance of seeing a network doctor, co-payments and deductibles will be higher, if the charges are higher than that of an in-network doctor the additional cost would be at the cost of the insured as the insurance company will still only pay in-network charges.
A POS, Point of Service, is considered a combination of a PPO and an HMO. The insured will choose their primary physician and all care should start with consulting this physician. The physician will refer the insured to a specialist in or out of the network. If the insured chooses to see a specialist without the referral of their primary physician the insurance company can and may refuse to pay for treatment or services.