Network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Insurance Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more insurance comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Maine
MaineCare is Maine's Medicaid program. It includes Maine's Children's Health Insurance Program (CHIP), which provides MaineCare coverage to children under 18 whose families have a higher household income. It also includes coverage for pregnant women whose gross monthly household income falls below specific limits. Eligibility is based on state residency. There is no waiting period and enrollment is open. Coverage is extremely comprehensive. Premiums are range from free to a maximum of $64 per month, depending on income level. Modest co-pays may be required for some services based on income.
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