The Different Types of Health Insurance Plans

Health care in the United States is very expensive and most of us don’t have enough funds readily available to pay the entire medical bill, which can run into the hundreds of thousands of dollars really quick.

By buying a health insurance policy – you will get the treatment you need without facing major bills from doctors and other medical providers.

Today, most people in America have some sort of private healthinsurance or participate in public programs such as Medicare or Medicaid. However, many citizends are un-insured bacause of finances and/or pre-existing conditions.

Under the Affordable Care Act, all Americans will be able to get health insurance regardless of income or health history.

You can get health insurance plans to meet individual requirements. When you compare options, it’s important to understand what they are. Here is a summary:

HMOs – Health Maintenance Organizations and EPOs – Exclusive Provider Organizations

HMO/EPOs might limit coverage to health service providers that are within their network of providers which consists of a list of doctors, hospitals and other health care providers providing medical care to subscribers to a specific health plan.

Should you go to a doctor that is not in the HMO/EPO’s network – you may have to pay the full cost of the services provided. With a HMO you usually have a primary care physician and must get referred to see a specialist. This is often not true for EPOs.

PPOs – Preferred Provider Organizations and POS – Point-of-Service plans

These plans give you a choice of getting care within or outside of a network. With PPO/POS plans you may use out-of-network providers and facilities – but you will have to pay more than if you use in network ones. Under a PPO plan you can visit any physician you want without being referred.

Under a POS plan you can visit any network provider without being referred – but you will need a referral to visit a provider outside of the provider’s network.

HDHP – High Deductible Health Plan

These plans for the most part feature lower premiums and higher deductibles than other health insurance plans. In 2013, HDHPs are plans with a minimum deductible of $1,250 per year for individual coverage and $2,500 for families. If you have an HDHP plan you can use a health savings account or a health reimbursement arrangement to pay for qualified medical expenses.

Catastrophic Health Insurance Plan

This health plan covers most essential health benefits. The difference is that the plan has a very high deductible. It provides sort of a “safetynet” coverage just in case you have an major accident or a serious sickness. Catastrophic health insurance plans do not provide coverage for services like prescription drugs or shots for the most part.

Catastrophic plans will generally have lower premiums, protect against high out-­of-pocket costs, and cover  recommended preventive services without cost-sharing. Also providing  affordable individual coverage options for young adults and people who qualify for certain hardship exemptions from the requirement to maintain health insurance coverage.  Marketplace catastrophic plans cover three annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of Essential Health Bene?ts that other Marketplace plans cover. If you enroll in a catastrophic plan, you cannot use a Premium Tax Credits to lower your monthly premiums.

In the Marketplace, catastrophic plans are available only to people under 30 and to people who have received certain “hardship exemptions.”  Each member of the family must meet eligibility requirements to purchase.

Premiums might be lower than other health insurance plans – but deductibles are often considerable higher. Means you will have to pay 1,000s of dollars yourself before full insurance coverage kicks in. In the Marketplace catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received “hardship exemptions”.

 

Affordable Healthcare Gov | Healthcare Marketplace 2016 | Healthcare Gov Website