Health Plan Options
Understanding your coverage can be confusing. We're here to help.
In order to help you be informed of the differences in plan types we have provided a brief guide below. If you have any questions about different types of insurance coverage, please contact our Patient Care Coordinators at 831.465.7800.
Health Maintenance Organizations (HMOs)
An HMO plan provides comprehensive coverage by requiring patients to receive services from a contracted group of providers.
As an HMO member, you must choose a Primary Care Physician (PCP) that will coordinate your health care and refer you to a Specialist if medically necessary. You may be responsible for co-payments, deductibles or fees for non-covered services. If you choose a DHMN administered HMO, you will have access to all our patient resources including our Patient Care Coordinators.
Medicare Advantage HMO (MAPD)
MAPD plans provide an alternative to Original Medicare coverage.
If you are eligible for Medicare and have both Part A and Part B coverage, you may qualify to enroll in a Medicare Advantage Plan. These plans include drug coverage and typically offer more services than Original Medicare. All DHMN providers accept MAPD plans.
Preferred Provider Organizations (PPOs)
Insurance companies contract with medical groups and hospitals to provide medical services to PPO patients for discounted rates.
If you chose a PPO, you select a PCP from a generally broad preferred provider network in order to receive your benefits at a lower cost. If you receive care from a doctor not in the network then your fees may be much higher. The care you receive from a PPO plan is not coordinated which puts greater responsibility on the patient.
Point of Service Plan (POS)
A POS plan allows patients to choose to receive service from their participating medical group or from a non-participating provider, with two different levels of benefit.
There are many version of this type of benefit and some employers offer their employees the option of choosing from several of these plans with various out-of-pocket implications.
Indemnity Plans/”Fee for Service”
These plans allow you to choose your providers from any group or health care facility.
You are responsible for a percentage of your health care costs, which may take the form of deductibles or reimbursements. This type of insurance often does not cover preventive care.