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| Health maintenance organizations (HMOs)
| Point of service (POS) plans
| Preferred provider organizations (PPOs)
| Traditional insurers
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| Free choice of physician?
| No. Treatment by physicians outside of the network is not covered.
| Yes, but treatment by physicians outside of the network is covered at a lower level.
| Yes, but treatment by physicians outside of the network is covered at a lower level.
| Yes
|
| Co-payment or coinsurance required?
| Minimal
| Yes. Typically higher for non-network care.
| Yes. Typically higher for non-network care.
| Yes. Generally 20% for medical and hospital services.
|
| Deductible required?
| No
| No deductible for network care.
| Yes. Typically higher for non-network care.
| Yes. Some plans offer a choice of a higher deductible for a lower premium, or vice versa.
|
| Required to consult a primary care physician (PCP) before seeing a specialist?
| Yes
| PCP must be consulted before seeing specialists within the network; no PCP for non-network care.
| No
| No
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| Emergency care covered?
| Emergency care by non-network physicians may be covered. Definition of "emergency" is often very strict.
| Varies from plan to plan.
| Generally provides the best coverage for emergency care by non-network physicians.
| Yes
|
| Limit on out-of-pocket costs?
| Usually no, but you are typically responsible only for co-payments.
| Usually yes, your out-of-pocket costs include deductible and coinsurance amounts.
| Usually yes, your out-of-pocket costs include deductible and coinsurance amounts.
| Usually yes, your out-of-pocket costs include deductible and coinsurance amounts.
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