Types of Health Insurance Coverage Plans
Health insurance can be a complicated topic, and it is made even more so from the uncertainty of what the state of health insurance will be in the United States in the near future.
However, it is still important to understand the types of health insurance plans that can be utilized by people to protect their health and well-being. There are different plans for different types of individuals with different needs.
For example, a young, physically-active consumer might require less coverage than a person entering the retirement age with a history of diabetes.
Types of Health Insurance
Because of this, it’s important to ask how your plan fits into your needs. Does your family have a history of mental health issues to worry about? Does your dental cover special procedures, such as crowns, or only basic cleaning?
Are you particularly at risk for behavioral disorders, like addiction, and require coverage for that? These are all things to ask yourself when picking an insurance plan. Here is some information about the differences between general insurance structures…
Preferred Provider Organizations
Preferred provider organizations (or PPOs) are built to keep medical costs going to a specific network of professionals. Because of this, copays are low for certain doctors within the network, but extremely high or incredibly complicated for doctors that are outside the network.
Typically deductibles are high, if you choose to use a medical professional outside of the network, in order to incentivize you to only use certain organizations or individuals. The benefit, though, is that you don’t need a referral to see specialists, or a note from a primary physician, so long as you are within the network.
Health Maintenance Organizations
Health maintenance organizations (or HMOs) are a fairly cheap structure of health insurance. They tend to be made to cater towards larger groups of individuals, such as businesses, rather than single individuals who are looking for health insurance.
Due to their low cost, and the fact that they are convenient for businesses that offer health insurance, HMOs are quite popular. Most HMOs are built for preventative care, in order to keep costs down over time. Because of this, most types of medical specialists are covered in some way under HMOs.
Exclusive Provider Organizations
Exclusive provider organization plans (or EPOs) are a more strict version of preferred provider organization plans. They are similar, in that there is a network of specialists and physicians that you are allowed to see, but there is no flexibility to see anyone outside of that network without some sort of explicit exception.
The good news, though, is that this tends to keep costs down within the network, and there are usually lower copays and deductibles to worry about with exclusive provider organization plans.
Point-of-Service
Point-of-Service plans are built to offer coverage to a wide variety of different specialists for different medical needs, but these must all be referred to through a primary care physician (your “point” of service).
For this reason, they are incredibly similar to preferred provider organization plans, in that there is a specific network that you have to pick your primary care physician from, and he will probably only refer to you specialists within that same network.
What is nice, though, is that your primary care physician is likely to refer you to preventative care, in order to keep costs low throughout the network.
Fee-for-Service
Fee-for-service plans don’t have many restrictions at all. There is no network that you have to pick from, in terms of medical professionals that you choose to visit.
You can take up visits with any sort of specialist you desire, whether you are recommended to them by a primary physician or not. There are some limitations that are specified in each plan, but they are typically much fewer than on other types of coverage plans.
The negative side of fee-for-service plans, however, is that they can be more expensive, and typically have higher deductibles with less payouts.
Category: Health Insurance
