Section 14 - HEALTH INSURANCE

Parts A and B - Privately Obtained Health Insurance

1. Health Maintenance Organization (HMO)

Expenses usually covered in full, or there may be a modest co-payment at the time of your visit.

• Group/staff type: You go to a central facility (group health center) to receive care.

• Independent practice association (IPA): Providers work from their individual offices (and are referred to as primary care physicians.)

2. Fee for Service Plan (FFS or PPO)

You or your insurance company are generally billed after each visit. In a traditional fee for service plan, you may go to any doctor or hospital you choose. In a preferred provider organization (PPO), you are given a list of doctors from which to choose. If you go to a doctor on the PPO list, more expenses are covered than if you go to a doctor not on the list.

3. Commercial Medicare Supplement (Medicare Advantage, Medicare Part C, Medigap)

Voluntary contributory private insurance plan available to Medicare recipients. Covers the costs of deductibles, co-insurance, physician services, and other medical and health services.

4. Other Special Purpose Plan

Covers only specific health needs, generally one type of service. Examples include:

Do not include Medicare Prescription Drug (Medicare Part D) plans.

Part C - Medicare, Medicaid, and Health Insurance Not Paid for by the Household

• Medicare (Parts A & B)
• Medicare Prescription Drug Plan (Part D)
• Medicaid
• VA Medical, CHAMPVA, Children's Health Insurance Program (CHIP), Indian Health Service (HIS)