Choosing the right health insurance plan for you and your family can be difficult. This is because there are many factors you must compare and different types of insurance to pick. You only have a short window of time to select the best strategy for you and your family, but hurrying and selecting the incorrect strategy can be expensive and time-consuming.
You have several choices when looking for an insurance plan. You’d have to choose from the different plans available, going through their benefits and the level of services, including bronze, silver, gold, and platinum.
About 60% of your medical expenses are covered by bronze, 70% by silver, 80% by gold, and 90% by platinum. Their benefits vary depending on the insurance agency and the type of insurance plan you choose.
There are four common types of health insurance plans. Before choosing the right plan for you, you must understand the meaning of the available plans, what they offer, how the plans differ from each other, and what services they cover.
Knowing the different plan kinds will make choosing one that will fit your demands and budget easier.
Different Types of Health Insurance Plans
Health Maintenance Organization (HMO)
In HMO, all healthcare services are provided by a group of physicians registered under the HMO. Every medical care will be provided by these health workers only, and the services are limited.
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In HMO, you’ll get:
- A healthcare provider assigned to you
- Fewer documents to sign
- A primary care physician will oversee your care and refer you to specialists as needed so that the health plan pays the costs of the service; most HMOs require a reference before you can see a specialist.
What doctor can you see: if you see a doctor or physician that isn’t registered under your HMO plans, you’ll have to cover the medical bills by yourself.
What you pay for:
- Premium is the total monthly or annual cost for the insurance plan.
- Copays or coinsurance for each type of care. Copays are usually about $10 to $15; you pay a flat fee whenever you get medical care. Coinsurance is the percentage you pay on charges every time you get treated.
- Deductibles are all the extra charges that come with the plan, like the coinsurance percentage.
Exclusive Provider Organization (EPO)
In EPO, healthcare services are provided by doctors, specialists, hospitals, and other healthcare providers to their members, except in emergencies.
In EPO, you’ll get:
- Unlike in HMO, members can choose their health provider, and you do not need a referral from your doctor to see a specialist.
- There’s a lower premium cost.
- Lesser paperwork.
- You’ll have to pay the bills fully if you see a doctor or specialist outside the health provided available in the EPO plan.
What doctor can you see: If you see a specialist outside the EPO assigned health providers, you’ll have to pay the medical fees.
What you pay for:
- Premium costs of the insurance.
- Some EPOs may have deductibles.
- It may also include copays and/or coinsurance.
- Other costs included, e.g., external charges from other doctors
Preferred Provider Organization (PPO)
In PPO, you pay less if you receive medical care from any of the registered health workers under the PPO plan. But you can also use other doctors and specialists outside of the PPO at an additional cost.
In PPO, you’ll get:
- More freedom than an HMO to select your healthcare providers; you do not need a referral from your primary care physician to see a specialist.
- Extra additional cost to see an outside doctor or specialist
- More paperwork, especially when you want to see an out-of-network specialist. If you visit a doctor who is in-network with the PPO, there’s little to no paperwork. You must pay the provider if you use an out-of-network service. After that, you must submit a claim for the PPO plan to reimburse you.
What doctor can you see: You can see any doctor you want, but you’d have to pay more.
What you pay for:
- Premium charges monthly or yearly
- Deductibles charges
- Copay and/or Coinsurance charges
- Other charges
Point of Service Plan
The POS plan pays less if you use any of the health providers registered under the POS, including clinics and hospitals. Additionally, POS plans call for a referral from your primary care physician before you can see a specialist.
In POS, you’ll get:
- More freedom to choose your provider than you would in HMO.
- Reasonable amount of paperwork. If you use an out-of-network provider, you’d have to pay the medical bill yourself and then write a claim to the insurance to pay you back.
- A primary care physician organizes your treatment and makes specialized referrals for you.
What doctor can you see: You can see the health provider assigned to you or an out-of-network provider with extra charges.
What you pay for:
- Premium charges
- Higher deductible charges to see an out-of-network provider
- Copay and/or coinsurance are higher when you see an out-of-network provider.
When deciding on what health insurance to choose for yourself and your family, it is important to compare health insurance. What you choose will help you determine your out-of-pocket costs and the doctors you can see. Make a list of the benefits you want from your health insurance, the types of services you want them to provide, and how much your budget is for the costs.