The 4 Basic Types of Florida Health Insurance

Throughout the State of Florida there are hundreds of Florida health insurance plans.  However, there are only four basic types.  They are…

Traditional

Traditional insurance is the oldest form of Florida health insurance. Also known as indemnity or fee for service insurance. Policyholders are free to utilize the services of the doctor, hospital or medical facility of their choice. Coverage is very straightforward. The insurance company pays your medical provider’s fee, less your deductible and/or co-insurance. However, keep in mind that generally traditional insurance is very expensive and limited in its scope of coverage for ‘well-care’ i.e. physicals, routine office visits and immunizations.

Health Maintenance Organizations – HMO

Health Maintenance Organizations, also commonly known as HMO’s are quite different from traditional health insurance plans. With preventative medicine in mind, HMO’s encourage physicals, flu shots, mammograms and well baby care. The hope is that through regular medical care, serious illnesses can be prevented or treated during early stages. Small co-pays for doctor visits and prescription drugs enable patients to maintain this level of preventative care. This type of plan is becoming more and more expensive due to the unexpected high utilization rates of individuals and groups. In other words, with very low co-pays, and out of pocket expenses, individuals are less likely to be concerned with the actual costs, visiting the doctor more often, and having more diagnostic tests done.

HMO’s require patients to appoint a gatekeeper physician (referred to as your family doctor) to coordinate all medical care. Additionally, HMO policyholders must utilize a pre-determined network of doctors, hospitals and medical facilities. This aspect of HMO insurance is often the most controversial because of the availability of services in your area. There is always the concern that you may need a level of care that is not available in your HMO’s network. Whether or not coverage will be extended outside the network, is left in the hands of HMO administrators. Also, HMO’s are often more expensive nowadays than the newer hybrid plans which combine features of both the PPO and HMO plans to decrease utilization which in turn reduces the final costs to your business.

Preferred Provider Organizations, PPO

Add one part traditional and two parts HMO and you have the perfect recipe for a Preferred Provider Organization (PPO). PPO’s offer policyholders a more liberal approach to managed care. You are not required to appoint a primary care physician, and can coordinate your own medical care within the PPO network. To receive the highest level of benefits, you are required to utilize the PPO’s network of doctors and hospitals. However, unlike an HMO, you are able to seek coverage outside the network. But keep in mind; you will have to pay a higher deductible and/or co-insurance for that convenience.

Point of Service plans or POS

This type of plan is somewhat of a hybrid between an HMO and a PPO.  POS plans require that there be a participating hospital in the county where you live or where your business is located.  The benefits are very much like an HMO in that the copay and out of pocket costs are relatively low compared to a PPO plan.  The premium cost for a POS plan in Florida is usually a little less than the PPO plan.  Referrals or gatekeepers are normally not required but in rare cases they may be.  Most POS plans do not require that a primary care physician coordinate your care.

Whenever considering managed care products, whether it be a HMO or PPO, there is no guarantee that your favorite doctor will be a participating physician. One other important factor to always consider is that the networks are not static. Doctors and hospitals can join or withdraw from a network at any time.  It is always best to call your insurance companies’ customer service dept to verify if a doctor or other medical provider is in the network whether it be a HMO, PPO, POS, or traditional fee for service plan.

Choosing the right Florida Health Insurance Plan is an important decision, but it often can be complicated. As with any other major purchase, it is important that you understand the options available to you.  If you have questions call and speak to one of our advisers at (888)-564-2326.