Health Insurance Plan Types

  • PPO plans are the most flexible. On this health insurance plan you do not need a primary care doctor. You are free to visit any health care provider in or outside your network without a referral.  If you elect to go outside your network, you will get less coverage from a PPO insurance plan. PPO plans tend to have higher premiums, co-pays and co-insurance.
  • HMO plans are the most restrictive. On this health insurance plan, you choose one primary care doctor from the insurance company’s provider networks. All your health care services must run through that doctor. This means that you must get a referral from your primary care doctor to visit any other health care provider. Emergency care services are an exception to the referral rule. You must pay for all medicals costs for visits outside of your health insurance’s network. HMO plans tend to have lower premiums, co-payments and co-insurance.
  • POS health insurance plans are a combination of PPO and HMO plans. You must choose a primary care doctor and likely need a referral to visit other healthcare providers. You can still receive coverage outside of your insurance plan’s network but if you do not get a referral for an out of network healthcare provider then your out of pocket expenses will be significantly higher.
  • EPO health insurance plans are generally much like HMO plans except you likely do not need a referral from your primary care doctor to visit other healthcare providers.

Understanding the important features of a healthcare plan

  • Co-payment- A fixed amount you pay after you have met your deductible. You usually pay it at the time of the doctor visit. Health Insurance pays the rest of the medical bill.
  • Deductible-The amount you pay in a given year for covered health care services before your health insurance company begins to pay.
  • Co-insurance-This is the portion of a medical bill you pay after you meet your deductible. For example, if your bill is $100 and your co-insurance is 20% then you pay $20 and your health insurance pays $80.
  • Out of pocket max- The highest amount you could pay in a given year for health services. This amount is calculated by adding your deductibles, co-payments and co-insurance together. After you pay the max the health insurance company pays 100% of your covered health care services.
  • Premium-The amount you must pay to maintain a health insurance policy