CARE FOR ALL [PART 3]
Selecting a medical plan: what to know about the different types
Medical plans are often categorized by network access and referral requirements, and HSA or HRA access.
Know what the different plan types mean so you’re ready when it’s time to make a plan choice.
Network access and referral requirements
Network access and referral requirements
HMO
Health Maintenance Organization
HMO
Health Maintenance Organization
Doctor/provider choice
In-network only except for true emergencies May be required to use insurance-owned facilities (like Kaiser)
Primary care physician (PCP)
Must select your specific primary care physician or one might be selected for you
Seeing a specialist
Insurance requires a referral from your primary care physician
EPO
Exclusive Provider Organization
EPO
Exclusive Provider Organization
Doctor/provider choice
In-network only except for true emergencies
Primary care physician (PCP)
A primary care physician selection is generally not required
Seeing a specialist
Insurance usually does not require a referral from your primary care physician, but the specialist might
POS
Point-of-Service
POS
Point-of-Service
Doctor/provider choice
In- and out-of-network care
Primary care physician (PCP)
A primary care physician selection may be required
Seeing a specialist
Insurance often requires a referral from your primary care physician
PPO
Preferred provider organization
PPO
Preferred provider organization
Doctor/provider choice
In- and out-of-network care
Primary care physician (PCP)
A primary care physician relationship is encouraged, but not recorded by the insurance company
Seeing a specialist
Insurance often does not require a referral from your primary care physician, but the specialist might
HSA or HRA access - (all plan types above may come with either an HSA or HRA)
HSA or HRA access - (all plan types above may come with either an HSA or HRA)
| Type & definition | What to know |
|---|---|
HRA | •The HRA is tied to a specific medical plan •Your employer sets aside a specific dollar amount for you to use towards qualifying medical expenses |
| HDHP with HSA | HSAs come with a qualified HDHP (sometimes called CDHP). These plans: •meet minimum deductible and maximum expense requirements •only cover preventive care before the deductible is met •usually cost less (have lower premiums) than other medical plans |
Only you can decide which plan type is best for you.
Along with these items, consider adding your annual cost for coverage (premium) to the out-of-pocket maximum for each plan to get your total maximum liability for the year.
