Understanding Health Plans
Are you searching for a health plan but not sure which one to
choose? Choosing the right health plan to suit your health and
financial situation is important. But understanding and comparing the
different plans can often be confusing.
The two most common types of health plans are:
- Preferred Provider Organization (PPO). A PPO allows you to choose
any health care provider, but offers incentives to members who
choose “preferred” or in-network physicians or hospitals. Providers
within this network agree to accept a set fee from the health plan,
while members are responsible for a small portion of the cost, called
a copayment. An example of a PPO is HMSA’s Preferred Provider Plan (PPP).
The PPP has the largest network of health care providers in the state,
including all major hospitals.
- Health Maintenance Organization (HMO). An HMO is a managed-care plan that
requires you to select a personal care physician (PCP) who will treat you
and coordinate your care with specialists and other health care providers
under a single health center. An HMO comes with fixed copayments, which make
the cost of your health care predictable. An example of an HMO plan is HMSA’s
Health Plan Hawaii.
If you are not eligible for health coverage through an employer group plan,
you can enroll yourself or a family member in one of HMSA’s individual plans.
There are PPO and HMO plans for individuals, as well as specialized plans for
children, students, the self-employed, and Medicare beneficiaries.
Some health plans may include supplemental benefit coverage for prescription
drugs and dental, vision, and complementary care (acupuncture, chiropractic care
and massage therapy). Just like the health plans, supplemental coverage usually
comes in a PPO or HMO version.