Family Health Budget - Health Plan Comparison

What is it? What's a network?	With an HMO, you select a personal doctor – sometimes called a Primary Care Physician, or "PCP" – who is in the plan's network. Your personal doctor tends to most of your health needs and refers you to a specialist in the network if necessary.	With this plan, you get coverage for doctors in AND out of the plan's network. You pay less when you go to participating providers (doctors, hospitals, and other providers in the plan's network).	This specially designed Preferred Provider Organization (PPO) plan has an integrated deductible — one deductible that combines health care and prescription drug expenses.

How much are premiums? What's a premium?	May be higher HMO plans sometimes have higher premiums than other types of plans, because the out-of-pocket costs tend to be lower.	Usually in the middle There are many types of PPO plans, so premium costs vary. Usually, the lower the deductible, the higher the premium – just like with car insurance or a homeowners' policy.	Generally lower Since this is a high-deductible plan, your premium is likely to be lower than with a traditional (low-deductible) PPO or HMO plan. In the insurance world, a higher deductible usually means a lower premium – and vice versa.

Do I have copayments? What's a copayment?	Yes Copayments depend on the plan you choose and the type of service you receive. For example, you 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 you to pay a percentage of your costs, and others have both. For plans with copayments, the amount usually ranges from about $10 to $300, depending on the service you receive.	It depends Generally you pay all expenses until you meet the deductible, so you don’t have copayments. However, some plans cover certain important preventive services even before you meet your deductible – so you pay nothing for these services or just a small copayment.

Is there a deductible? What's a deductible?	It depends Some HMO plans don't have a deductible – you pay a copayment, and your plan takes care of the rest. But others have a deductible for certain expenses, like prescription drugs.	Usually The deductible for participating providers can range from $250 to $5,000 per person… or $500 to $10,000 for a whole family.	Yes In 2005, the minimum deductible set by the Internal Revenue Service (IRS) is $1,000 for single coverage and $2,000 for family coverage.

Can I get a health care spending account? What's a health care spending account?	FSA With an HMO plan, you can also put money in a Flexible Spending Account (FSA), which allows you to set aside tax-free dollars for copayments, prescription drug costs, and other items on your employer's approved list.	FSA and HRA With a PPO plan, you can have a Flexible Spending Account (FSA) that you put money into, a Health Reimbursement Arrangement (HRA) your employer puts money into, or both.	HSA, FSA, and HRA This is the only plan that allows you to put money in a Health Savings Account (HSA). But you can also get a limited Health Reimbursement Arrangement (HRA) or Flexible Spending Account (FSA) with this kind of plan.

Any Drawbacks?	Limited provider choices HMO plans usually cover only participating providers – doctors, hospitals, and other providers in the plan’s network – unless it’s an emergency. And your PCP handles most of your care, so you’ll need a referral to see a specialist.	Out-of-network charges PPO plans allow you to go to any provider, but you’ll pay a larger share of your costs if you choose a doctor, hospital, or facility that isn’t in the plan’s network … plus those costs don’t count toward your in-network deductible.	Higher, integrated deductible Since this kind of plan tends to have a higher deductible than a traditional PPO plan, you could have higher out-of-pocket costs. Some people consider the integrated medical and pharmacy feature a drawback; others consider it an advantage.