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Comparison of typical health plans

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Health maintenance organizations (HMOs) Point of service (POS) plans Preferred provider organizations (PPOs) Traditional insurers
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
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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