When choosing a health insurance plan, you have to consider what each type of plan pays for. Some policies pay 100 percent of medical costs, while others pay only a small percentage. Some insurance plans are better for young people and those who have few medical expenses. These policies come in three main categories: Catastrophic coverage, Bronze, and Silver.
Catastrophic coverage
Catastrophic coverage in health insurance refers to a plan with high out-of-pocket costs or limited coverage of day-to-day medical expenses. Under the Affordable Care Act, this coverage has been transformed into a distinct category of individual insurance plans. These plans are sold in insurance exchanges and through insurance companies. However, you must be under the age of 30 to purchase a catastrophic health plan. In addition, these plans cannot be purchased with a government subsidy.
Catastrophic health insurance plans are mainly available for people who are under 30 years old and those who qualify for a hardship exemption. For instance, people under 30 who are unemployed or have recently gone through a financial hardship may qualify for this plan. In addition, a person may qualify for an exemption if he or she has a child who is a tax dependent. In some states, there are other exemptions, such as affordability.
As a general rule, catastrophic health insurance plans cover the same essential health benefits as other Marketplace plans. However, they must also cover some preventive health services at no cost. For example, a catastrophic plan must pay for at least three primary care visits every year until the deductible is met. After that, the plan will pay for all covered services.
Catastrophic health plans are less expensive than bronze plans, and they cover similar benefits. However, catastrophic plans require you to choose three primary care providers.
HMOs
HMOs are types of health insurance that coordinate health care services by a network of doctors and hospitals. They are often based on a geographical area or job location, and are designed to limit out-of-pocket medical expenses for members. HMOs may also allow members to visit out-of-network medical professionals. The benefit of HMOs is that premium costs tend to be less than those of other forms of health insurance.
Since the early 20th century, HMOs have become more popular. The Health Maintenance Organization Act of 1973 helped increase their popularity by clarifying how HMOs should operate and requiring large employers to participate in an HMO. HMOs have since grown into one of the most prevalent forms of health insurance in the United States, with over 29 million Americans receiving care through HMOs in 1987. HMOs are an important aspect of health care insurance, and health care providers need to be familiar with them.
Another type of HMO is the Individual Practice Association (IPA). These organizations are comprised of independent medical practitioners. They can be HMO members or non-members. Another type of health insurance is the Point-of-Service plan, which is a hybrid between an HMO and a PPO. A PPO pays more for services rendered within its network but reimburses health care providers for services received outside the network.
HMOs come in two basic models: open-panel and staff models. In the open-panel model, the physician is not employed by the HMO directly but instead is a member of the organization. In open-panel HMOs, a patient’s primary care physician can refer them to a physician outside of the HMO. An open-panel model also allows patients to receive partial coverage for certain services.
PPOs
Preferred provider organizations are the most common type of health insurance plan. They allow you to visit doctors you trust, and they generally offer lower prices. They are also popular among large employers. In a recent survey, 47% of people reported having an employer-sponsored PPO plan. A PPO plan also helps you get better care at a local clinic or hospital.
With an HMO, you may not have much choice when it comes to where you receive medical care. Using a specialist outside of the PPO network may cost you a higher coinsurance percentage, and you’ll need to pay up front and submit a claim for reimbursement. A PPO plan works similarly to an HMO, with a network of doctors and a PCP. However, you’ll have to see a doctor that participates in your network, unless you’re in an emergency. You may also have to pay up-front and pay a deductible, and may not be covered for all of the services.
A PPO plan offers a network of health care providers and requires referrals from your primary care provider. However, it does allow you to choose a doctor who accepts your preferred PPO plan. A PPO plan also offers greater flexibility, with members having the option of using out-of-network providers, but these out-of-network doctors will charge a higher share of your premium.
While PPOs are typically the most expensive health insurance plans, they may be the best option for individuals with specialized needs. For example, a PPO plan may be the best option for someone with chronic back pain, who needs a specialist chiropractor.
EPOs
While most HMO plans require members to have a primary care physician (PCP), an EPO plan does not. Instead, it covers doctors and hospitals in the network of that plan. Members must use only those providers in the network. In many cases, they cannot see doctors outside of the network, with the exception of emergencies. An EPO is similar to an HMO in that subscribers pay a monthly premium to get health coverage, but they are free to see any provider in the network. Copays and coinsurance may also apply.
When choosing an EPO, make sure to read the fine print. Some plans require referrals from a primary care physician. If a specialist is needed, the plan may require preauthorization. Be sure to contact the plan’s customer service line to verify if a specific doctor is in network.
Depending on your health insurance plan, you may have to choose between an HMO and an EPO. HMOs offer more flexibility, but you have to choose a plan that fits your needs. EPOs are more expensive than HMOs. They may not be available to you if you’re buying coverage on your own, but they are becoming more common in the individual market.
When choosing a health insurance plan, it’s important to keep in mind the cost and convenience. Each plan offers different benefits and services, and you should compare these options before making a final decision. Consider the health and financial situation of yourself and your family before making a final decision. If you’re looking for the least expensive option, an HMO is often the best option.
HMOs and PPOs are the most common types of health insurance plans. Exclusive provider organizations (EPOs) are rarer, but they still have many advantages. They allow for greater flexibility in finding a doctor. For instance, they allow you to get specialty care without a referral. Although the coverage offered by EPOs is lower than that of an HMO, the premiums are lower than those of PPOs.
HDHPs
HDHPs are types of health insurance plans that require you to pay a high deductible before you can access your health insurance benefits. An HDHP will be helpful if you are young and healthy, but if you have a chronic health condition or take multiple prescription medications, an HDHP may not be for you. Before enrolling in an HDHP, you should compare the coverage options, including out-of-pocket expenses, and the network of doctors and hospitals.
The cost of insurance has increased in the last couple of years, with the average family premium increasing nearly half a percent between 2016. Thankfully, HDHPs are now available to those who cannot afford to pay high premiums. These health insurance plans also come with lower monthly premiums. However, they require enrolling in a state-offered health savings account (HSA), which lets members contribute the money they would have otherwise spent on premiums to an account. Eligible employers can also contribute to a HDHP if it is available to their employees.
HDHPs are typically cheaper than PPOs. However, they have smaller networks and higher premiums. HDHPs also have co-pays and coinsurance, which will be part of your bill if you visit a hospital. Co-insurance costs vary depending on the type of service you need.
High-deductible health plans can be advantageous for people who do not have serious medical conditions or are young and healthy. However, they may not be the best option for people with chronic conditions. The costs associated with HDHPs may make it impossible for them to get treatment for potentially life-threatening symptoms, leading to larger medical bills.
