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.
Political positions of Donald Trump
Trump has cited the rising costs of premiums and deductibles as a motivation to repeal the Affordable Care Act. However, according to a study by the Kaiser Family Foundation, the after-subsidy premium costs to those with insurance coverage via the Affordable Care Act's exchanges did not change significantly on average from 2016 to 2017, as increases in the subsidies offset pre-subsidy insurance premium increases. For example, after-subsidy costs for a popular "silver plan" remained around $200/month in 2016 and 2017. An estimated 70% of persons on the exchanges could purchase a plan for $75/month after subsidies. Further, in the employer market, health insurance premium cost increases from 2015-2016 were an estimated 3% on average, low by historical standards. While deductibles rose 12% on average from 2015-2016, more workers are pairing higher-deductible plans with tax-preferred health savings accounts (HSAs), offsetting some of the deductible increase (i.e., lowering their effective deductible).