Types of Health Insurance*

Health Maintenance Organization (a.k.a. HMO, EPP)

    This type of insurance involves finding a primary care physician (PCP), who will manage all of your health care needs. You MUST get a referral from your PCP for any additional health care that you need. In addition, if you need to see a specialist, you almost always have to see a specialist that is also contracted with the insurance company (i.e., your PCP may not be able to refer you to anyone he or she believes is good). You can only see a specialist outside of the insurance company's network when the insurance company does not have this type of specialist in their network. Typically, you will have to pay to see health care professionals (e.g., $10 per visit; this is called a "co-pay"), and then your insurance company covers the rest of the costs. Many HMO/EPP plans include a pharmacy plan, in which you pay a certain set amount for medications (e.g., $10 co-pay) and then the insurance company covers the remaining amount.

Preferred Provider Organization (a.k.a. PPO)

    This type of insurance involves a "network" of health care professionals. The health care professionals within this network have agreed to charge a certain amount for their services (and this amount is below what they would normally charge). You are able to see anyone that is in the network (within reason), and you will pay a certain percentage and the insurance company will pay the rest (e.g., you pay 20% of the costs, the insurance company pays 80% of the costs). If you see someone who is outside of the "network", then you have to pay a greater percentage (e.g., you pay 50% of the costs, the insurance company pays 50% of the costs).

Fee for Service (a.k.a. FFS)

    This type of health care insurance is becoming extinct. It is the type of insurance that many people are familiar with, as this is what you probably used to have. The FFS insurance policy allows you to see any health care professional, you pay a certain percentage of the health care costs (e.g., 20%) and the insurance company pays the remainder (e.g., 80%).


* This web page is designed to provide information and does not constitute development of a professional relationship. You are strongly encouraged to speak to the health care professional(s) who are treating your chronic illness to obtain a suitable referral.

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