California State Logo

 

HMOs, PPOs, & Other Health Insurance

There are many kinds of health insurance. Each type has rules that you must follow to get care. This page tells you about common kinds of health plans.

Three kinds of plans

Most Californians have an HMO or PPO.  Some Californians have a fee-for-service plan, but that is less common.

  • An HMO (health maintenance organization has a network.  These are the doctors, hospitals, labs, and other providers in the plan. You must get your care from these providers.
  • A PPO (preferred provider organization) also has a network. You usually have more choices of doctors in a PPO and the cost is usually higher.
  • Fee-for-service insurance (indemnity insurance) usually costs more than HMOs and PPOs, but it gives you the most choice of doctors. Usually, you pay part of each bill, and the doctor bills your insurance company for the rest.

 

High-deductible health plans

Some HMOs, PPOs, and fee-for-service plans are high-deductible plans.  High-deductible plans have lower premiums but higher deductibles, compared with typical health plans.

 

Group vs. individual plans

You may have an HMO, PPO, or fee-for-service plan through your job, or you may buy a plan on your own.

  • If you have health coverage through a job or union, you have group coverage. Some group plans are self-insured and have special rules.
  • If you buy health insurance on your own, not through a job or union, you have individual coverage.

 

Government and public programs

  • Medicare is the federal health insurance program for people who are 65 or older, and for some people under 65 who have a disability. Medicare Advantage plans are usually HMOs or PPOs. Traditional (or Original) Medicare is more like fee-for-service health insurance.
  • Medi-Cal is health insurance for people with low incomes. Many counties have Medi-Cal Managed Care plans, which are like HMOs. Some people have regular Medi-Cal, where each doctor you see sends the bill to the state.
  • Veterans health benefits are available to many people who serviced in the U.S. armed forces or were called to duty in the Reserves or National Guard. Benefits are also available to some family members of certain eligible veterans.

Resources

DHCS Medi-Cal

Medicare

VA health benefits

Covered California