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.
Massachusetts health care reform
By comparison, Commonwealth Care insurance had either zero or $250 deductibles (depending on which of three types of Commonwealth Care insurance it was) and zero or very low co-pays as compared to the PPACA-consistent insurance (not illustrated in the table). "Not applicable" in the table above means the subscriber (a) cannot go out of network at all or (b) can go out of network but will be responsible for all charges incurred; it does not mean the deductible does not apply. Both Commonwealth Care and PPACA-consistent insurance is networked and almost all versions of both insurances offered gym memberships.