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Deductible

Medical insurance plans have a deductible. The deductible is your first out of pocket cost or the upfront money you pay to obtain outpatient and inpatient care. Similar to your auto insurance the deductible is the first expense you pay, then the insurance company pays. Examples of services require paying a deductible are emergency room visits, inpatient and outpatient care and lab work (also see Coinsurance). In an HSA Plan your doctor office visits and prescriptions are also subject to the deductible before the insurance will pay for services.

See an example.

Copay Plan

A copay plan is the term we use to describe a medical insurance plan that has a designated copay amount that members pay for doctor office visits and prescription drugs. Instead of paying the deductible first for these services, there is cost-sharing between the covered member and the insurance company usually in a dollar amount between 15 dollars and 65 dollars.

See an example.

HSA Plan

An HSA plan is the second type of medical insurance plan you can purchase. Many companies offer an HSA plan alongside a copay plan. The HSA allows for members to place tax-free dollars into a savings account that can be used for medical expenses or can be saved year after year. HSA plans do not have copayments for doctor office visits or prescriptions. All services are subject to the deductible.

See example.

PPO

PPO stands for Preferred Provider Organization. It is a network option for your medical insurance plan. PPO plans have the most doctors, clinics, and hospitals In-Network. PPO plans typically do not require referrals, and they will offer some benefit for providers outside of their preferred list.

EPO

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HMO

HMO stands for Health Maintenance Organization. This is where your medical insurance rates are much less expensive and your value of coverage is usually better than a PPO or EPO health plan.   HMO's are exclusive provider networks, like Kaiser Permanente has an HMO network where all your medical coverage is obtained through a Kaiser Permanente facility with Kaiser employed Physicians and Nurses and Staff. Because costs are easier to manage in an HMO you pay less and get more for your money and still obtain high quality medical care for you, and or your family members.

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