Types of Health Insurance

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When do I need health insurance?

It is a good idea to have health insurance if you are not covered as a dependent under someone else’s health plan, such as a spouse/partner or parent. A health insurance plan can assist you in managing both your health care needs and costs.

Without insurance, the cost of health care can be quite high.

What are the different types of health insurance?

The different types of health insurance, include:

  • Health maintenance organizations (HMOs)
  • Exclusive provider organizations (EPOs)
  • Point-of-service (POS) plans
  • Preferred provider organizations (PPOs)

Not sure which types of health insurance are best for you? The following is a general description of each of the types of health plans.

health maintenance organizations (HMOs)

HMOs, require you to choose from a local network of participating doctors, hospitals, and other health care professionals and facilities. You must also select a primary care provider (PCP) from the network with these health insurance plans.

Your primary care physician (PCP) is your medical home base. They get to know you and assist you in coordinating all of your medical care. They’ll also need to refer you to one of their in-network specialists.

As long as you stay in-network, the costs of an HMO plan—copays and coinsurance—are typically lower than those of other types of health plans.

exclusive provider organizations (EPOs)

You can choose from a network of participating providers with an EPO. Except in the case of an emergency, most EPO plans do not cover out-of-network care.

This means that if you visit a provider or facility outside of the plan’s local network, you will almost certainly be responsible for the entire cost of services.

You may or may not be required to select a primary care provider, depending on the plan (PCP). You don’t need a referral from your PCP to see a specialist in your network.

point of service plan (POS)

HMO and PPO features are combined in point-of-service plans. In comparison to a PPO plan, the provider network is typically smaller, and the costs for in-network care are typically lower.

You must also select a primary care provider (PCP) from the plan’s network of doctors and other primary care professionals with a POS plan. Your PCP is your go-to person for medical advice and care.

They get to know you and your medical needs, and they can assist you in coordinating your care.

You must obtain a referral if you need to see a specialist. You can choose to see specialists who are in-network or out-of-network, just like with a PPO.

If you see a doctor outside the plan’s network, your share of the costs will be higher and you’ll be responsible for filing any claims yourself.

preferred provider organizations (PPOs)

PPOs usually have a large network of participating providers, so you can choose from a wide range of doctors, hospitals, and other healthcare professionals and facilities.

You can also see providers who are not part of the plan’s network, but you will have to pay more out of pocket.

These health plans do not require you to choose a primary care provider (PCP), and you can see specialists without a referral.

What types of health insurance are best for me?

Start by understanding your specific health care needs:

  • If you’re in good health and don’t visit a doctor often, health insurance plans with higher deductibles typically have lower insurance premiums and could help save you money.
  • If you require or expect more than just preventive care, consider plans that have lower deductibles and coinsurance, for more predictable costs.

I have a long-term illness. What are the best types of health insurance for me?

Chronic illnesses may necessitate regular medication and more frequent doctor visits, as well as expensive hospital stays and/or surgeries. Consider a health plan that helps you save money on doctor visits, specialist visits, prescription medications, and other out-of-pocket expenses.

Planning ahead of time will assist you in selecting the appropriate types of health insurance.