Good health is a necessity for everyone. As such, there are many brands offering insurance for it. Aside from that, you can purchase insurance from your employer (Job-based insurance) or even from the state.
Here, we will focus on Health Insurance Plans you can source from the marketplace – private insurance companies and brokers.
Health insurance plans are the medical plans managed by your insurer on your behalf. Each plan will offer different benefits and services – also called Summary of Benefits and Coverage (SBC) – that will reflect the policyholder’s health condition, budget, and the medical services that are covered.
Selecting your plan comes in knowing how the health care cover will be of service and what it entails. If, for instance, you have a pre-existing health condition that requires you to see a specialist, if would be wise to consider which insurance network provider he participates in as this will greatly affect your out-of-pockets.
That said, someone else’s sound healthcare plan, may not apply the same for you.
The main health insurance plans are:
With each plan, as we will come to see, there are different benefits provided, and degree of freedom in choosing the preferred health provider entitled to the policyholder. Similarly, there exists constraints varying from one plan to another.
A popular health insurance plan for many is an HMO. Compared to other options, this is the cheapest medical plan as its premiums are generally lower than those of other health care plans.
HMOs give you a local network of participating doctors, hospitals, and pharmacies that you are required to choose from. Another requirement, is for you to choose a Primary Care Provider (PCP) within that network who will act as a Gatekeeper, and help coordinate all your care and medical needs.
Seeking health care from providers outside the network, will have you be fully responsible for your bills. Apart from that, you’ll always need a referral from your PCP to see specialists from within your plan’s network.
Like HMOS, EPOs generally won’t include coverage from out-of-network participants. They will, however, allow you to visit specialists from within your network without any referral from your PCP, who in most cases, you will not be forced to choose.
EPO networks are slightly larger compared to ones from HMOs. This gives you greater freedom in seeking care from physicians and specialists you want.
Since you’ll be dealing mostly within the network, both HMOs and EPOs will involve little paperwork on your part, a huge hinderance when filling for claims from out-of-network providers in the other medical plans.
PPOs typically include a large network of health care providers with some coverage from out-of-network participants.
Like EPOs, there’s freedom in choosing your Primary Care Physician. This also comes without needing referrals for visiting both on-network and out-of-network providers. You, however, have to deal with your own paperwork when filing for a claim after receiving medical care out-of-network.
With that said, PPOs are usually the most expensive health insurance plans, with higher premiums and out-of-pockets like co-pays.
A POS Insurance Plan combines features from both HMOs and PPOs. With it, policyholders are required to have a PCP who will handle all their care and can provide referrals for visits to in-network providers, and those from out-of-network.
Out-of-network medical care will also be covered but will be subjected to higher out-of-pocket expenses and more paperwork.
Similar to HMOs, Point of Sale networks are also localized, making it difficult to stick exclusively to one, for all your medical needs.
Though, anyone can access these medical plans, they are not, in their entirety, fit for everyone. It is important to figure out before hand, which one makes the most sense to you. By consulting an insurance expert, you will be made aware of each plan’s features and see if those match up to your situation.
Knowing which Insurance Plan is best for you comes first in understanding your specific health care needs. If you are in good health and don’t visit the doctor as often, choosing a health plan with higher deductibles could save you money throughout your policy’s life as they typically come with lower premiums.
On the other hand, if you have an existing health condition or expect more than just routine care or check-up, choosing a plan with less out-of-pocket expenses, like deductibles and co-insurance, will trigger your insurance early and in the process, minimize your out-of-pocket expenses.
Similarly, you should also consider other factors like:
You can visit any health care provider you wish so long as they are in-network. If they are out-of-network, medical rates might be much higher, where you might be partial or fully responsible for.
Yes, there are. HSAs – Health Savings Accounts – allow you to put up tax-free savings once you are eligible for certain plans, like High Deductible Health Plans (HDHP).
Yes. In fact, most plans allow you to receive free emergency care from any health provider. However, it is important to read the fine print, to know exactly how your insurer defines one.
No, you need not as most health insurance plans stipulate for free preventive care like annual check-ups and vaccination.