Are you currently shopping for health insurance? Are all of the different types of health insurance plans confusing you? While there is a vast variety of options available, they each serve their own purpose.
If you’re wondering which is the right one to choose, it’s best to start with the basics by understanding what your needs are. To learn more about the various medical insurance options, continue reading the content below.
Why Have Health Insurance?
Before delving into the different health insurance options or working out how to navigate the florida marketplace health insurance (or whichever state you live in), it’s important to realize why you should have coverage in the first place. Unless you are under your spouse’s health insurance or as a dependent on another person’s plan, it’s important to have medical coverage.
Insurance ensures that you are okay in the event that something goes wrong with your health. For instance, if you’re hurt and you need to go to the emergency room, insurance covers that. If you are diagnosed with an illness, medical insurance pays those regular doctor visits.
However, even if your health is in stellar condition, it’s still important to go get routine checkups to ensure that everything is okay. It’s nice to have medical coverage that pays for exams like annual doctor visits, pap smears, colonoscopies, and mammograms.
In most cases—depending on the type of health insurance that you get—you’ll have to pay copay or coinsurance costs. But medical coverage takes care of the majority of your expenses that you would otherwise have to pay out pocket for.
Not to mention, there are some treatments and surgeries that the doctors won’t perform unless insurance is on file for it. After reading this post and understanding what to look for, learn which Medicare Supplement plans are best for you before making your final decision.
The Various Types of Health Insurance
The different variety of health insurance plans includes the following:
- Health Maintenance Organizations
- Preferred Provider Organizations
- Exclusive Provider Organizations
- Point of Service Plan
Each of these plan types offer different features to best suit you or your family’s needs. Here are more details about each of them:
Health Maintenance Organizations (HMOs)
Health maintenance organization plans are one of the most common types. HMOs offer a local network of doctors, hospitals, and other medical facilities to patients. Individuals with HMO plans have to choose a physician within that particular network of doctors.
This type of plan also requires patients to select a Primary Care Provider ( PCP) from within that Network. The PCP acts as the home base for the patient.
When the patient has health issues that require the help of a specialist, the primary care provider refers them to a specialist or surgeon within their network of doctors. Since this type of plan is more restrictive, the cost for copays and coinsurance is a lot less than other insurance types.
However, the cost is only low if you stay in-network. Individuals that choose to visit an out-of-network doctor are subject to paying higher fees or potentially the entire expense out of pocket.
Preferred Provider Organizations (PPOs)
Preferred provider organizations are for those who need variety with their healthcare coverage. PPOs consist of a large network of physicians, specialists, hospitals, and other medical facilities to select from.
With this type of plan, you have the option to visit out-of-network doctors, but you have to pay more out of pocket. Also, with a PPO plan, selecting a primary care provider isn’t mandatory and you have the option to see a specialist without getting a referral from your PCP.
A PPO plan is great for individuals who have serious health problems and don’t want the extra hassle that comes with an HMO plan. HMOs are restrictive and getting a referral approved by the insurance company is sometimes a headache.
Exclusive Provider Organizations (EPOs)
An exclusive provider organization plan offers insurers a network of participating physicians to select from. The majority of EPO plans exclude medical coverage for out-of-network providers— except in emergency situations.
Basically, if you visit a doctor or medical facility outside of the plan’s network, you’ll probably have to pay the entire amount of the healthcare bill. Also, depending on the type of EPO you choose, you may be required to select a primary care physician.
But on the bright side, if you need to see a specialist within your network, it doesn’t require a referral from your PCP.
Point of Service (POS)
Point of service plans offer the best of both worlds when it comes to the features provided in HMO and PPO plans. This plan consists of a smaller provider network than PPOs, and the price for network medical care is generally lower as well. The costs are more like the prices for HMO co-pays.
However, a primary care physician is mandatory on a POS plan and you have to choose one from within your specific network of doctors. They’ll be the basis of your healthcare needs and help you get a referral to a specialist if need be. On a POS plan, referrals are required.
On the other hand, you can visit an out-of-network specialist with a POS plan. But the price for seeing an out-of-network specialist is more expensive on a POS plan.
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Understanding the Variety in Health Insurance
It’s important to understand that there’s variety in health insurance because everyone has different needs. It wouldn’t be very fair if medical insurance was the same across the board. Although it’s a bit confusing to figure it all out, the different plans are designed to suit your lifestyle.
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