Joel Lee Health Markets can help you search for a health insurance plan from different companies to find coverage that suits your needs and fits your budget. There are several types of health insurance types that meet different needs. Understanding the main types of health insurance plans will make the selection process less overwhelming, and it will be a step towards achieving affordable health plans. Knowing the different types of health insurance plans will prepare you for evaluating your options every year.
Health Maintenance Organizations (HMOs)
A health maintenance organization delivers all health services through various healthcare providers and institutions. This type of cover may give you the least freedom to select your healthcare providers and have the least paperwork than other plans. The plan also gives you a primary care doctor who will manage your care and refer you to specialists if you need them, so the health plan covers the care.
You can see any doctor in your HMO’s network, and if you visit a doctor who is not in the network, you may have to pay the bill out-of-pocket. With an HMO, you will pay premiums, deductions, and copays for every type of care.
Exclusive Provider Organizations (EPOS)
Exclusive Provider Organizations provide the beneficiary with a moderate amount of freedom for choosing their healthcare providers, unlike with HMO. With this type of plan, you will not need a referral from your primary doctor to visit a specialist.
Exclusive provider organizations do not cover the out-of-network providers; therefore, you may pay the bill if you see any out-of-network providers. The plan also has a low premium. You will pay a deductible, copay, and other costs in the case of an out-of-network provider. The Exclusive Provider Organizations (EPOs) have little to no paperwork.
Point-of-service (POS) plans
Point-of-service (POS) plans have both the features of HMO and PPO plans. With this type of plan, you will have more freedom to select your healthcare providers than an HMO. The paperwork is also moderate, especially when you see out-of-network providers.
POS allows you to have a primary doctor who will coordinate your care and refer you to specialists. If your primary care doctor refers you to an out-of-network provider, you may see them, but you will have to pay extra. With a POS, you pay premium, deductible, and copays. Going off the network will force you to pay your medical bill, then you can send a claim to the POS for a refund.
Preferred Provider Organizations (PPOs)
With a PPO, you can get a substantial amount of freedom to choose your healthcare providers than you would with an HMO. With a PPO plan, you do not have to get a referral from your primary care provider to see a specialist. Moreover, this plan has more paperwork than the other ones, especially when you see an out-of-network provider. Seeing out-of-network doctors will also cause you to pay higher out-of-pocket costs.
PPO requires you to pay a premium, deductible, copay, and other costs if the out-of-network provider charges more than his counterparts in the area. This type of plan only has little or no paperwork when you see an in-network provider. However, seeing an out-of-network provider will force you to pay the provider and send a claim to the PPO plan for a refund.