What Are the Different Types of Primary Care Insurance?

Malcolm Tatum

Primary care insurance is a type of health insurance package that is aimed at providing a range of medical services. Insurance of this type normally focuses on services provided by a general practitioner, making it possible to obtain care for a wide range of ailments, both short- and long term. Different types of primary insurance offer slightly different ways to go about getting the care needed and arranging for payment of covered health events. Three of the more common examples of primary care insurance include the primary care provider, the health maintenance organization, and the preferred provider organization.

The benefits summary for an HMO, a type of primary care provider.
The benefits summary for an HMO, a type of primary care provider.

One of the more common examples of primary care insurance is the preferred provider organization (PPO). With this arrangement, patients select a primary care physician from the list of those who have agreed to accept the insurance and extend certain benefits to the insured parties. The exact function of a PPO in terms of providing for medications, referrals to specialists, and other aspects of medical care will vary, but many plans will require that the primary care physician provide a referral before the insurance will cover any costs of specialized care. There is usually at least some coverage allowing the insured party to seek medical care out of the provider’s network, a benefit that can be helpful when the insured party is traveling.

The health maintenance organization or HMO is another example of a primary care insurance system that is very popular. With this program, subscribers are paying flat fees in advance for health care. A primary care physician must be selected from the list supplied by the HMO; in some cases, patients may be assigned by the HMO to a physician. There are sometimes no co-pays involved in routine doctor visits and in some cases the cost of medication is covered in full. Typically, the HMO will not pay for any medical services conducted by physicians or medical facilities outside their network, although some plans of this type do allow some leeway if an insured party is injured or is ill while traveling in an area not served by the provider.

A point of service program (POS) is another type of primary care insurance that is found in many areas of the world. With a POS, elements of both the HMO and the PPO are included. Plans of this type normally do not include any deductibles that insured parties must meet and co-payments are kept to a minimum. At the same time, there is more control over the choice of physicians than with the HMO, and the chances of having at least a portion of medical expenses sought from providers outside the network is much greater.

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