Health Insurance

HMO

Managed care plan requiring a PCP, referrals, and in network providers; low cost but low flexibility

Major Medical Plan

Broad, comprehensive insurance plan covering major medical services (hospital, ER, outpatient); an umbrella term, not a specific network type

What does a PCP do in an HMO

Acts as a gatekeeper, coordinating care and giving referrals to specialists

Are out of network servces covered in an HMO

No, except emergencies

PPO

Flexible network plan that allows out of network care, no referrals needed, but with higher premiums

Do PPOs require referrals to see a specialist

No

What is the main disadvantage of a PPO

Higher premiums compared to HMOs

What is the main advantage of a PPO

Flexibility to see any provider (in or out of network)

CDHP

High deductible health plan paired with a tax advantage account, encouraging cost conscious decisions

Why are deductibles high in a CDHP

To lower premiums and encourage consumers to pay attention to healthcare costs

HSA

Tax advantaged savings account owned by the employee, portable

HRA

Employer funded reimbursement account for medical expenses; not portable

Which plan requires a PCP and referrals

HMO

Who funds an HRA

Employer only

Are HRA funds portable if you leave your job

No

Which plan type allows out of network care

PPO

Which plan has the highest deductible

PPO

Which plan is the cheapest

HMO

Which plan is the most expensive

PPO

Premium

Monthly cost you pay to have health insurance

Deductible

Amount you must pay out of pocket before the insurance company starts paying for most services