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Types of Health Insurance Plans

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When purchasing health insurance, you need certainty regarding the type that best suits your need. There are different types of health insurance plans, with each having a way they operate. To enjoy the best from health insurance, you should purchase your plan correctly.

In this post, you’ll learn about the different health insurance plans in detail. Also, you’ll get answers to questions relating to the kinds of health insurance for more information to tailor your decisions. At the end of this post, you should have everything you need; therefore, stick with this post to the end.

What are the Types of Health Insurance Plans?

Below are the five primary types of health insurance plans which insurers may provide:

  • Health Maintenance Organizations (HMO)
  • Preferred Providers Organization (PPO)
  • Point-Of-Sale Service Plans (POS)
  • Exclusive Provider Organization (EPO)
  • High-Deductible Health Plans (HDHP)

Health Maintenance Organizations (HMO)

HMOs require you to choose from a network of participating physicians, hospitals, and other health care experts in your area. You must also select a primary care physician (PCP) from the network for these health insurance policies. 

Your medical home base is your primary care physician (PCP). They get to know you and help you coordinate all of your medical care. They’ll also have to refer you to an expert in their network. 

HMO copays and coinsurance are frequently less expensive than those of other types of health plans. All it takes is for you to stay in-network.

An HMO provides all healthcare services through a network of healthcare experts and facilities. It may provide you with the following advantages:

  • You have the fewest options when it comes to choosing your healthcare providers.
  • This plan contains the least amount of paperwork when compare to others.
  • A primary care physician should supervise your treatment and refer you to specialists. Meanwhile, your health plan would pay for the service. Also, most HMOs demand a referral before you may see a specialist.
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HMO involves no paperwork.

What doctors can you see?

You can see any of your HMO’s network members. You may be responsible for the entire bill if you see a doctor, not in the network. Non-participating doctors can bill you in the hospital, but emergency services must receive reimbursement at in-network rates.

What would you pay?

  • Premium: This is the amount you pay each month.
  • Deductible: Your plan may require you to pay a deductible before it would cover treatments, except for preventive care.
  • Copays or coinsurance for each type of care: You pay a copay when you receive medical treatment, which is usually $15. They’ll refer to you as coinsurance when you pay a percentage of care costs, such as 20%. They subtract these fees from your deductible, and it varies with your plan.

Preferred Providers Organization (PPO)

PPOs often include an extensive network of participating providers. It allows you to choose from various doctors, hospitals, and other healthcare professionals and facilities. You can also see providers who aren’t on the plan’s network, but you’ll have to pay a higher out-of-pocket fee.

You don’t have to pick a primary care physician (PCP) with these plans, and you may see specialists without a referral.

With a PPO, you may get:

  • More options for healthcare professionals than you would with an HMO. Also, you don’t need a referral from your primary care physician to see a specialist.
  • Out-of-network doctors’ out-of-pocket expenses are more significant than in-network doctors’.
  • You’ll have to fill out more paperwork with out-of-network providers than with other plans.
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What doctors can you see?

Any doctor in the PPO’s network, out-of-network doctors are more expensive.

What would you pay?

  • Premium
  • Deductibles: For some PPOs, a deductible may be necessary. Your deductible will almost probably be higher if you see an out-of-network doctor.
  • Copay or coinsurance: When you obtain medical care, you pay a copay, usually $15. When you pay a percentage of treatment costs, such as 20%, you refer to coinsurance.
  • Other expenses: You may be liable for the difference after your insurance has paid its half. This is if your out-of-network doctor charges more than other doctors in the area.

Point-Of-Sale (POS)

The advantages of an HMO and a PPO come together in a POS plan. With a POS plan, you could have the following:

  • Unlike an HMO, you have more freedom in selecting your healthcare providers.
  • Expect to fill out documentation if you see an out-of-network provider.
  • A primary care physician

What doctors can you see?

In-network providers might be referred to you by your primary care physician. Out-of-network doctors are available, but they are more expensive.

What would you pay?

  • Premium
  • Deductible
  • Copay

Paperwork is necessary. If you go out of network, you must pay your medical bill. Then you submit a claim to your POS plan for reimbursement.

Exclusive Provider Organization (EPO)

Here’s what an EPO provides:

  • You have more healthcare providers to choose from than with an HMO. Also, you don’t need a referral from yours. 
  • It doesn’t cover out-of-network doctors. Iyou’ll be responsible for the entire bill f you see a doctor who isn’t part of your plan’s network.
  • Lower premium than the same insurer’s PPO.
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What doctors can you see?

Any EPO network provider, out-of-network providers are not covered.

What would you pay?

  • Premium
  • Deductibles
  • Coinsurance or copay
  • Additional costs: You will be liable for the entire amount if you visit an out-of-network provider.

Documentation is necessary. A limited amount of documents is necessary for an EPO.

High Deductible Health Plans

Like a high-deductible health plan, a catastrophic health plan may allow you to pay less for your insurance (HDHP). With an HDHP, you could experience the following:

  • Health plans include HMOs, PPOs, EPOs, and POSs.
  • Higher out-of-pocket costs than many other types of plans. The plan pays for your whole treatment, just like other plans, if you reach your maximum out-of-pocket limit.
  • It can help you pay for your medical care. To be eligible for an HSA, you must register in an HDHP.
  • Several bronze plans may qualify as HDHPs, depending on the deductible.

 

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