Managed care
In terms of using such a plan, unlike an HMO plan, which has a copayment cost share feature (a nominal payment generally paid at the time of service), a PPO generally does not have a copayment but offers a deductible and a coinsurance feature. The deductible must be paid in full before any benefits are provided. After the deductible is met, the coinsurance benefits apply. If the PPO plan is an 80% coinsurance plan with a $1,000 deductible, the patient pays 100% of the allowed provider fee up to $1,000. The insurer will pay 80% of the other fees, and the patient will pay the remaining 20%. Charges above the allowed amount are not payable by the patient or insurer but written off as a discount by the physician.
High-deductible health plan
The proposed American Health Care Act of 2017 could result in higher deductibles (or total out-of-pocket cost) to consumers and leave 23 million Americans without insurance, according to the Congressional Budget Office. The Trump Administration is proposing to nearly double the maximum HSA contribution for a family from $6,750 to $13,100 annually. An increase in HSA contribution limits will provide little benefit to the low-income households, which already find HDHPs to be less affordable in the event of a catastrophic illness. One method to entice consumers to pursue HDHPs is low- or no-cost wellness benefits, which provides the insured with better access to preventive care visits and tools at lower cost. If successful, these plans may support the ongoing shift from curative to preventive health care.