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 This information is intended for residents of the United States.
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Private Payers

Private payers and managed care organizations are commercial plans that cover a variety of medical care, drugs, and supplies. Private payers offer benefits through groups such as employers and unions, or patients can purchase individual plans directly from the payer. The type of private health insurance that an individual has typically affects the benefits that are available, the patient cost share for drugs and services, and how providers are paid.

Common Types of Private Payers
Indemnity
  • Offers greater flexibility for higher patient cost
  • Also referred to as fee-for-service plan
  • Patients can select their own healthcare providers and are not restricted to networks
  • Higher monthly premiums and deductibles
High-Deductible Health Plan (HDHP)
  • Higher deductibles and patient out-of-pocket costs than traditional plans
  • 2009 minimum annual deductible is $1,150 (individual) and $2,300 (family)
  • The 2009 maximum out-of-pocket amount is $5,800 (individual) and $11,600 (family)1
Preferred Provider Organization (PPO)
  • Offers members discounted rates for obtaining medical services directly with selected medical professionals
  • Referrals usually not required for specialty services
Point of Service (POS)
  • Offers greater flexibility for higher patient cost
  • Members may receive care from in-network provider
  • Medical care from out-of-network provider may result in higher cost sharing (similar to indemnity plans)
Health Maintenance Organization (HMO)
  • Generally has lower costs but places more restrictions on enrollees
  • Typically no deductibles, and patient has co-pays rather than co-insurance
  • Patients must use network provider only and obtain referrals from primary care physicians for specialty medical treatments

1. "Treasury, IRS Issue 2009 Indexed Amounts for Health Savings Accounts" U.S. Department of the Treasure. Press Release. May 13, 2008





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