Compare Types of Health Insurance Plans

Do you know the difference between HMO, PPO, and POS health insurance plans?

Even if you think you're sure you do, it's worth making sure you understand the differences when you're considering what type of coverage best meets your needs.

Please see the chart below for details about these types of plans.

Health Maintenance Organization
Preferred Provider Organization
Point of Service
Annual Deductible No, most plans Yes, most plans No, for in-network coverage on most plans
Set Copayment Amounts Yes No Yes, for in-network coverage
Coinsurance Yes, some plans Yes Yes, for out-of-network coverage
Out-of-Network Coverage Emergent care only Yes Yes
Primary Care Physician Required Yes No Yes
Referral Needed No* No No
Chiropractic Care or Spinal Manipulation Included Yes, QHP plans** Yes Yes, QHP plans**
Premium Cost $ $$ $$$
Individual and Family Coverage Yes Yes*** Yes***
Preventive Care No charge No charge (in-network only) No charge (in-network only)
Lifetime Maximum No No No
Health Savings Account (HSA) Yes Yes Yes
Health Reimbursement Arrangement (HRA) Yes Yes Yes
Flexible Spending Account (FSA)**** Yes Yes Yes

*Optima Health does not require referrals for HMO plans; however other insurance carriers may require a referral for specialist treatment.
**Spinal manipulation is covered under all Affordable Care Act-compliant qualified health plans (QHP).
***Optima Health does not currently offer Individual & Family PPO or POS plans.
****Flexible Spending Accounts are generally offered by an employer and are not specifically tied to a health plan.

Funding Options for Consumer Driven Plans

Health Savings Account
Flexible Spending Account
Health Reimbursement Account
Who Contributes? Employee and/or Employer Employee Employee and/or Employer
Pre-Tax Contribution? Yes Yes Yes
Uses Qualified medical expenses Qualified medical expenses Qualified medical expenses
Unused Funds at End of Year Roll over to next year Use it or lose it Given back to employer

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