Individual Health Insurance Coverage: HMO PPO POS FFS Health Facts

By Jessica Farrell

Choosing the right type of individual health insurance is an important step in looking after yourself. The main three choices when it comes to Individual Health Insurance coverage are Fee-for-service, HMO and PPO.

Fee for service means that you can go to any doctor in the country and you do not need referrals for specialists. This is the most flexible type of cover, and often the most expensive too. You pay a monthly premium and a yearly deductible which is a payment you must make before any insurance payments are made. Certain costs are taken out of this deductible, whilst others may not be covered by it.


HMO stands for Health Maintenance Organization. These organizations tend to place a high importance on keeping you well, and are good at preventative care, simply because they don’t make any more money the sicker you get. The downside is that you must choose a doctor from their list, and if you need to see a specialist you must have a referral from your primary care doctor.

PPO stands for Preferred Provider Organization. This is a combination between the HMO and the Fee for service provider. There are a limited amount of doctors you can see, however you will still receive some coverage if you see doctors who are not part of your PPO’s organization.

Fee for service, HMO and PPO providers are beginning to take leaves out of the others books however, so whereas in the past a HMO might have offered the cheapest health care and the least flexibility, that may not be the case today.

You really do have to shop around and see what each plan offers. A fee for service plan may have unexpected restrictions, or a HMO plan may include costs you might not expect.

You might also want to consider Medicare or Medicaid if you are disabled or come from a low income family. Eligibility varies from State to State, so if you think you might be eligible, do look into it.

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