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.
John C. Goodman
Today's tax law places rigid restrictions on how HSAs can be used. For example, there must be an across-the-board deductible, covering all medical expenses. However, Goodman now argues that we should have accounts with no deductibles or copayments. For example, employees could be given an account from which to manage all primary care. Diabetics and patients with other chronic conditions could manage their own budgets along with incentives to manage their own care.