Types of plans

Choosing a health plan can pretty complicated. Luckily, we’re here to make things simple. Keep reading to learn about some common plan types so you can easily choose one that’s right for you.

PPO (preferred provider organization)

PPO plans let you see any provider you prefer in HMSA’s network of participating providers. You can also see nonparticipating providers, but they may charge more than participating providers. That’s because HMSA and participating providers have agreed to charge members a set fee, also known as the eligible charge. PPO plans work best for people who value choice and are willing to pay higher monthly premiums for that freedom.

HMO (health maintenance organization)

With an HMO plan, you pick one health center and a primary care provider (PCP) in that health center to provide or arrange your care. Your PCP will refer you to specialists and other health care providers in your health center when you need it. If a provider in your health center isn’t available to give you the care you need, your PCP may refer you to a provider outside of your health center.

While you usually have less choice of doctors with an HMO, you’ll probably pay lower monthly premiums than you would for a PPO plan.

High-deductible health plan

This plan has low premiums and a high deductible, so you’ll pay less for monthly premiums and pay more when you receive services. It’s a great option if you don’t expect to use many health services. With this type of plan, it’s a good idea to use a health savings account (HSA) or health reimbursement arrangement (HRA) to help pay for your care.

Medicare Advantage

Medicare Advantage, also known as Medicare Part C, has more benefits than Original Medicare and is available to people age 65 or older and certain disabled individuals. It combines hospital (Medicare Part A), medical (Medicare Part B), and sometimes drug (Medicare Part D) benefits. Insurance companies contract with the federal government to offer Medicare Advantage plans. Most of these plans also offer extra benefits like discounts for hearing aids and fitness centers.

With this plan, you have a network of doctors and hospitals - similar to an HMO - that are cheaper to go to than providers outside of the network. So if you already have doctors you like, make sure they’re in the network of the Medicare Advantage plan you enroll in. Most of the health plans we discussed earlier may include some or all of these benefits:

  • Medical.
  • Dental.
  • Prescription drug.
  • Vision.

Sometimes, you can mix and match plan types, like having a medical PPO and a dental HMO. Check with your insurer to find out what your plan covers and what your options are.

Do you have Medicare questions?
Sage PLUS counsels members with Medicare as well as their families, caregivers, and agencies throughout Hawaii.

Are you looking to choose a plan or change to a different plan?
Here’s a list of eight things to think about when choosing or changing plans.

Supplemental

Most insurance plans pay for basic medical care like a doctor’s office visit, surgery, and hospitalization. But if you want added protection for medical expenses that aren’t a benefit of your health plan, you may need to buy separate supplemental insurance.

Supplemental insurance may include:

  • Accidental death and dismemberment for critical injuries.
  • Alternative medicine such as acupuncture, chiropractic care, and massage therapy.

Check with your health insurer to find out what kinds of supplemental plans they offer.

Still not sure which plan is best for you?

Here are some questions you should consider:

A B
  • Do you have medical problems that require a lot of doctor visits, treatments, and medications?
  • Do you expect to be hospitalized or need surgery?
  • Are you accident-prone and do you end up in the ER a lot?
  • Are you in pretty good health?
  • Do you rarely have to see a doctor or go to the hospital?
  • Do you need insurance "just in case" for emergencies?

If you answered yes to any of the questions in column A, you may want a health plan that pays most of your health care expenses. However, keep in mind that these plans typically have higher monthly premiums.

If you answered yes to any of the questions in column B, you may want a health plan that has lower monthly premiums, such as a high-deductible plan. However, keep in mind that you may have to pay more when you go to the doctor or hospital.