It’s Difficult to Choose When You Don’t Know
It can be difficult to navigate the health insurance marketplace by yourself. There are a lot of rules that vary by state, and the overall system can have communication issues. I’m going to show you the four basic types of health insurance plans here so you can make a more informed decision about what you should do.
When you own your own business or simply need coverage because your employer doesn’t provide it, I can help you find what you need. These plans apply to individuals and families alike. But, for now let’s assume that you’re looking just for yourself. Here’s what you need to know:
4 Basic Types of Health Insurance
HEALTH MAINTENANCE ORGANIZATIONS (HMOS)
These are plans that offer a wide range of services through a network of providers. This means you’ll have a lot of options when it comes to picking doctors as well as more preventive healthcare services. These providers are under contract with the HMO and offer lower premiums as a result. Basically, what this means is that you are charged lower fees because the providers don’t have to invest in finding patients. You’re directed to them through the network.
HMOs provide health insurance coverage when you pay either a monthly or annual fee. You may be required to work or live in the plan’s network area in order to be eligible. They also require that you choose a primary care doctor. They typically have low or no deductibles (the amount you pay health care services before your insurance plan starts to pay) as well as low co-pays (the amount you pay at the doctor’s office per visit before insurance is billed) which makes them useful for individuals and families.
EXCLUSIVE PROVIDER ORGANIZATIONS (EPOS)
These plans are considered a mixture of HMOs and PPOs. You have to stay within the network of healthcare providers to be covered like an HMO. However, emergency care is covered even if it’s outside of your network, and you generally don’t have to choose a primary care doctor. This plan often requires you to pay more out of pocket before it covers your medical expenses as well. It doesn’t require a referral to see a specialist but going outside of your network may require your insurance to pre-authorize a visit.
POINT OF SERVICE PLANS (PSOS)
These are similar to HMOs but allow patients to see out of network providers like EPOs. You may have to choose a primary care doctor who can refer you to a specialist if you need one. These usually have lower costs, but that comes with usually having a more limited list of providers. It allows you to go out of network but you’ll have to pay more than you would at an in network provider. However the POS plan will also pay more for out of network than a PPO.
PREFERRED PROVIDER ORGANIZATIONS (PPOS)
These plans have higher premiums than an HMO. You aren’t required to have a primary care doctor on this plan and in most cases prescription drugs are covered. In order to get Medicare drug coverage you have to be on a PPO plan that offers that type of coverage.
You don’t need a primary care doctor to refer you to a specialist but staying with an in network specialist will keep the costs lower. The “Preferred” part of PPO means that using preferred providers will lower your costs as well. It can offer extra benefits than just Original Medicare but that may be at an extra cost also.
How to Find Individual Insurance
You can reach out to me. I specialize in helping you find the right coverage. You can go toHealthCare.gov to apply through the ACA Marketplace or your state’s health insurance marketplace if that is required. The marketplaces, subsidies, programs, and plans vary by state.
I’ll walk you through the process and take your budget and needs into account when helping you find the coverage. This can be a messy and ever-changing industry and I make it my goal to help you navigate those changes and keep your costs low. I believe you should have health care coverage just like anyone else. Let’s find the right one for you today.
