Health insurance helps ensure a level of guaranteed wellness when certain unexpected medical incidents occur. Interestingly, the United States offers different types of health insurance plans to cater to different categories of people, ensuring that everyone is covered when faced with expensive medical treatment costs.
The core types of health insurance plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point-of-Service (POS), and Exclusive Provider Organization (EPO). Federal authorities (courtesy of the federal Health Insurance Marketplace) have also segmented health plans in the country into four levels, namely Platinum, Gold, Silver, and Bronze.
Types Of Health Insurance Plan In The U.S
Having the right understanding of the different health insurance available means being knowledgeable of the way each works and the cost attached. You can weigh the pros and cons of each health insurance plan and settle for the one that is consistent with your needs and level.
Health Maintenance Organization (HMO)
With this option, an individual can get healthcare services from an approved network of providers spread around the country.
If you want coverage, you have to live near the HMO’s service area because they usually don’t include out-of-network care, except in emergency cases. But it’s a good thing that the typical Health Maintenance Organization offers comprehensive coverage in terms of the care gotten.
Preferred Provider Organization (PPO)
This is a sort of upgrade of the first, particularly because an individual can go to out-of-network providers when they need healthcare services. However, the structure allows us to save more when staying in the network, although it can be more expensive when compared with other plans.
Another advantage of a PPO is that you don’t have to choose a primary care provider, and unlike an HMO where they need a referral to see a specialist if stepping out of network, this is unnecessary here. So, if you enjoy flexibility for the choice of a care provider, a PPO is what you need.
Point-of-Service (POS)
This has some similarities with both a PPO and an HMO when it comes to its fundamental features. The plan allows people to select a primary care provider from the network and also permits them to seek care outside of the network.
If you opt for this plan, you can decide to move out of network for healthcare services anytime you feel like, but may have to pay most out-of-network costs except when the primary care provider linked you with another medical doctor.
So, you should remember that, unlike an HMO, individuals who opt for a point-of-service plan may have to choose a primary care provider and even get referrals for special healthcare services.
Exclusive Provider Organization (EPO)
Like the POS, EPO also has some similar features to both PPO and HMO. With this managed care plan, individuals have coverage only when they visit in-network providers, but they can choose any primary care provider they prefer. Also, a person with this plan won’t have to wait for a referral to visit a specialist.
Obamacare Health Plan Categories
You can get a tailored made-for-you health insurance plan via the federal Health Insurance Marketplace based on the available categories already set via the enactment of the Affordable Care Act (ACA), which are: Bronze, Silver, Gold, and Platinum. The choice of plan determines the premiums and out-of-pocket costs for healthcare services.
Bronze
You will pay the least amount for premiums, although it carries the highest costs when you need healthcare services. This is mainly recommended for those who rarely visit a doctor and can also afford a higher deductible for healthcare needs.
Silver
Plans under the silver category come with a moderate monthly premium and moderate costs if the individual needs healthcare services. Unlike the Bronze plan, deductibles in the Silver plan are usually lower in some ways, and opting for this could help you qualify for cost-sharing reductions.
Gold
This is recommended for people who visit a doctor occasionally because it offers lower costs on a routine basis while having a high monthly premium. Also, Gold plans are known for low deductibles and it may not take the individual as long to reach the deductible.
Platinum
This has the highest premiums, but it is also known as the one that costs people the least out of pocket when they need healthcare services. Amidst the available plan tiers, its deductibles are usually the lowest.
Conclusion
Having an adequate understanding of the different types of health insurance plans in the U.S. will help you in choosing the right insurance for your needs.
Certain factors must be put into consideration before opting for any of the available health insurance plans, such as the situation of your overall health, what monthly premiums you can afford, if you have sufficient savings to cover deductibles, if you have any chronic conditions, and so on.