When do I need health insurance?
If you don’t have coverage as a dependent under someone else’s health plan, like a spouse/partner or parent, it’s 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 with their acronym in English) include the following:
- Health Maintenance Organizations (HMOs)
- Exclusive Provider Organizations (EPO)
- Point of Service (POS) Plans
- Preferred Provider Organizations (PPOs)
Not sure which types of health insurance are best for you? Below 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 to choose from. These types of health insurance plans also require you to choose an in-network primary care provider (PCP). 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 in-network specialists. Costs for an HMO plan, copays, and coinsurance are usually lower than other types of health plans, as long as you stay in-network.
What are Exclusive Provider 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 may 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 HMO and PPO plans. The provider network is typically smaller than a PPO plan, and the costs for in-network care are typically 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 need 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 the network. If you see a doctor outside of 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 large network of participating providers so you have access to many doctors, hospitals, and other health care professionals and facilities to choose from. You can also choose to see providers outside the plan’s network, but you will pay more out-of-pocket costs.
You are not required to choose a PCP with these types of health plans, and you can see specialists without referrals.
What are the ideal types of health insurance 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 with lower deductibles and coinsurance, so you can have more predictable costs.
I have a chronic condition. What are the ideal types of health insurance for me?
Chronic conditions may require regular medications and more frequent doctor visits, including expensive hospitalizations and/or 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.