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
To qualify for an HDHP, an individual plan must have a deductible of at least $1,350 and family plans must have a deductible of at least $2,700. An HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $6,650 for an individual or $13,300 for a family (This limit doesn't apply to out-of-network services). Because of the relatively high cost of HDHPs, the increased out-of-pocket costs can be burdensome especially for low income families. As a way to try and offset the cost of care, HDHP policy holders may contribute to a health savings account (HSA) with pre-tax income. HSA contributions, unlike other tax-advantaged investment vehicles, offer a triple tax benefit – tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. The maximum contribution limits policy holders may make to their HSA in 2018 are $3,450 (individual) and $6,900 (family) with a $1,000 catch-up contribution for people age 55 or older.