When do I need health insurance?
If you do not have coverage as a dependent within someone else’s health plan, such as a spouse / partner or parent, it is good to have health insurance. A health insurance plan can help you manage both your health care needs and costs.
The cost of health care without coverage can be significant.
What are the different types of health insurance?
The different types of health insurance (shown) include the following:
- Health Maintenance Organizations (HMO)
- Exclusive Provider Organizations (EPO)
- Point of service (POS) plans
- Preferred Provider Organizations (PPO)
Not sure which types of health insurance are the best for you? Here is an overview of each type of health plan.
What are Health Maintenance Organizations (HMOs)?
HMOs offer you a local network of participating doctors, hospitals, and other health care professionals and facilities from which to choose. These types of health insurance plans also require you to choose a primary care provider (PCP) from the network. Your PCP is the foundation for your health care. He knows you and helps coordinate all the care you need. They will also need to provide you with referrals to see specialists within the network. The costs for an HMO plan, copays and coinsurance, are usually lower than other types of health plans, as long as you stay in the network.
What are Exclusive Vendor Organizations (EPOs)?
An EPO offers you a network of participating providers from which you can choose. Most of these plans do not include coverage for out-of-network care, except in emergencies. This means that if you visit a provider or facility outside of the plan’s local network, you will likely have to pay the full cost of the services.
Depending on the plan, you may or may not be required to choose a Primary Care Provider (PCP). If you want to see a specialist in your network, you do not need a referral from your PCP.
What is a point of service (POS) plan?
Point-of-service plans combine features of the HMO and PPO plans. The provider network is generally smaller than a PPO plan, and the costs for in-network care are usually lower, like an HMO plan. PPO plans also require you to choose a primary care provider (PCP) from the plan’s network of doctors and other primary care professionals. Your PCP is the foundation for your health care and advice. He knows you and your health needs, and can help you coordinate all the care you need.
If you have to see a specialist, you will need a referral. However, as with a PPO, you can also choose to see specialists in or out of network. If you see a doctor who is outside the plan’s network, your share of the cost will be higher and you will be responsible for submitting your claims.
What are Preferred Provider Organizations (PPOs)?
PPO plans generally offer a wide network of participating providers so you can access many doctors, hospitals, and other health care professionals and facilities from which to choose. You can also choose to see providers outside of the plan’s network, but you will pay more out-of-pocket costs.
Choosing a PCP is not required with these types of health plans, and you can see specialists without referrals.
What types of health insurance are ideal for me?
Start by understanding your specific health care needs:
- If you’re in good health and don’t visit the doctor often, health insurance plans with higher deductibles generally have lower insurance premiums and could help you save money.
- If you need or expect more than just preventive care, consider plans that have lower deductibles and coinsurance, so you can have more predictable costs.
I have a chronic condition. What types of health insurance are ideal for me?
Chronic conditions may require regular medications and more frequent doctor visits, including hospitalizations and / or expensive surgeries. Consider a health plan that helps you minimize out-of-pocket costs based on what you anticipate for medical care, specialist visits, prescription drugs, etc.
Planning ahead will help you choose the right types of health insurance.