Health insurance or Medical Insurance plans are the product of collectivism in which people pool their risks. Here the risk is of incurring medical expenses. Medical Insurance plans come under various categories. All major medical insurance plans are briefly described here.

PPO health insurance: In Preferred Provider Organization plan, you are expected to use a network of preferred doctors and hospitals. They provide services at a discounted rate. If you use services from an out-of-network physician, it generally gets covered at percentage that is lower than the services rendered by a network physician. These are private medical insurance plans.

HMO: HMO health insurance is a health insurance product which is offered by a health maintenance organization (HMO), a type of managed care provider. HMO health insurance is widely used, and is popular for group insurance plans that cover the employees of a particular company, or members of a particular organization. There are advantages and disadvantages to HMO health insurance. These can be considered when deciding to buy an insurance product.

Supplemental Medical insurance: It is a type of insurance policy which is designed to cover the gaps in your regular health insurance due to deductibles and co-payments. Supplemental medical insurance covers additional expenses that your primary insurance doesn’t cover, such as lost income and living expenses. Those who should consider supplemental medical insurance are people who are self employed, and those with families and children. Others who find it stretched financially to handle large medical bills or those who have taken time off from work due to illness or injury, and those on Medicare also must consider this plan.

POS: Point of Service plans combine the features offered by HMO insurance and PPO insurance plans. Like in the case of an HMO insurance, you will be required to choose a primary care physician (PCP) from the plan’s network. PCP’s services are normally not subject to a deductible. Also, like HMOs, POS plans offer coverage for preventive care. However, you will receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider will generally be subject to a deductible and covered at a lower level. If services are rendered outside of the network, you may have to pay up-front and get it reimbursed.

Indemnity plans: A typical Indemnity plan offers a more freedom in choice of doctors and hospitals at a higher out-of-pocket cost and more paperwork. Under an Indemnity plan, you can consult whatever doctors or specialists you like, without any need for referrals. However this freedom has a price attached. You may be required to pay an annual deductible before the insurance company begins to pay on your claims. The insurance company typically uses a “usual, customary and reasonable (UCR) rate” for the service. It is the amount health care providers typically charge. You may have to pay up front and get it reimbursed. These are private medical insurance plans.

Medicare Advantage Plans: Private medical insurance plans offered by an insurance company that have a contract with Medicare. They provide you with all the Medicare Part A and Part B benefits. Medicare Advantage Plans are HMO health insurance plans, PPO Insurance plans, or Private Fee-for-Service Plans. If you have joined a Medicare Advantage Plan, Medicare services are covered by the plan. They are not paid by the Original Medicare.

MEDICARE ADVANTAGE PRESCRIPTION DRUG (MA-PD) PLAN: This is a Private medical insurance plans which offers Medicare Prescription Drug coverage. It also covers Medicare Part A and Part B benefits.

MEDICARE COORDINATED CARE PLAN: This is a Medicare Advantage plan combined with HMO or PPO Plan.

MEDICARE COST PLANS: These plans are a type of HMO that acts as a Medicare Health Plan. As with other HMO plans, this plan pays only for services outside its service area when there is an emergency. But, when you are enrolled in a Medicare Cost Plan, if a routine services is required outside of the plan’s network without a referral, the Medicare-covered services are paid for by the Original Medicare plan. You will be responsible for the Original Medicare deductibles as well as coinsurance.

MEDICARE COVERAGE
Made up of two parts: Part A: Hospital Insurance and Part B: Medical Insurance.

MEDICARE HEALTH PLAN
A plan offered by private medical insurance companies that contract with Medicare. These plans provide you with your Medicare Part A and/or Part B benefits .Medicare Health Plans include Medicare Advantage plans (including HMO Insurance, PPO health insurance, or Private Fee-for-Service Plans); Medicare Cost Plans; PACE plans; and special needs plans.

MEDICARE MANAGED CARE PLAN
This is a type of Medicare Advantage Plan which is available in many areas of the country. In most managed care plans, you can choose doctors, specialists, or hospitals which are in the approved list of the plan. The plan is expected to cover the Medicare Part A and Part B benefits. Some managed care plans additionally cover prescription drugs. It is possible that the costs are lower than in Original Medicare.

MEDICARE PRESCRIPTION DRUG COVERAGE
Optional coverage is available to all the people who have Medicare plans through insurance companies and other private companies.

MEDICARE PRESCRIPTION DRUG PLAN
A stand-alone drug plan, that are offered by insurers to beneficiaries who receive their Medicare Part A / B benefits through their Original Medicare plans; Medicare Private Fee-for-Service Plans that do not cover prescription drugs; and Medicare Cost Plans offering Medicare prescription drug coverage.

GROUP HEALTH PLANS
Medical insurance plans that provide health coverage to current employees, former employees and their families. These plans are supported by the employer organization.

Employee (or retiree) benefit plans established or maintained by an employer, an employee organization (such as a union), or a church group that provides medical care to employees and their dependents directly or through insurance (including and HMO), reimbursement or otherwise.

The above constitute all major medical insurance plans available today. All major medical insurance companies provide a wide variants of these plans. Your agent will be able to explain in more detail.

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