A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and gets a group of doctors to participate. Everybody agrees on certain costs and charges, which lets the insurance company control expenses and give you lower prices. But if you join an HMO and your previous doctor isn't a member, you can't bring him or her with you. HMOs work like this:

• You choose a primary care physician (PCP) from a list of participating doctors. He or she is your personal doctor, who you see for routine medical care like annual exams and health issues. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your doctor will refer you to a provider or facility. Your doctor must give authorization for those services to be covered by your HMO.
• You may have to pay some portion of the cost (called a co-payment) for each office or hospital visit, such as $15 per doctor visit, regardless of what the services cost.
• You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).
• You do not have to fill out claim forms, which makes this a relatively simple system.

PPOs offer choices and access, but there is typically a cost associated with that freedom that is higher than HMO costs. Like an HMO, it is a network, but rather than choosing a primary care physician, you can see any health care professional in the network any time you choose to make an appointment. You don't need referrals for specialists or other services. You can even see professionals outside the established PPO network, but if you do so, your portion of the costs will be higher. PPOs work like this

• You will have choices to make about your insurance options within the PPO system when you enroll. Your choices will apply to you and any dependents you enroll in the plan, and can usually only be changed once a year during "open enrollment" periods.
• You'll receive a list of participating medical professionals, which you can use to find health care. Or you may continue to see anyone you already use.
• You may have to pay a portion of the cost for each office or hospital visit, regardless of how much the visit costs. Your portion is the "co-payment."
• You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).

This is the least restrictive option of the three main plan types. TI lets you see any licensed health care professionals for anything covered by the insurance. You choose deductible and other options when you enroll, and those apply to you and any dependents you enroll in the plan. TI works like this:

• •   The deductibles you choose apply to each person enrolled in the plan (so if you and a spouse enroll and select a $250 deductible, you each must pay $250 in medical expenses before your plan starts paying further costs each year). But companies typically set a maximum of two or three deductibles per family.
• •   Costs that exceed your deductible are covered by a coinsurance plan, so you and the insurance company share the cost for services covered by the policy. For example, with an 85/15 provision, the insurance company pays 85% and you pay 15%.
• •   After you meet your deductibles, coinsurance maximums apply that protect you from skyrocketing bills.

You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).