Health Insurance Types

HMO

(Health Maintenance Organization) An HMO provides less freedom to choose a provider, but there’s less paperwork/no claim forms to fill out at the doctor’s office. Usually a primary care doctor must refer you to go to a specialist. The costs include a monthly premium, a deductible up to a certain amount, and copays at the doctor’s office.

PPO

(Preferred Provider Organization) A PPO gives you moderate freedom to choose a provider, and you don’t need a referral for a specialist. It comes with higher costs for you if you see an out-of-network doctor, and you’ll pay a premium, a deductible, a copay and an out-of-network doctor fee. There is usually no paperwork (or limited amounts) when you’re in-network, but more if you go out-of-network.

EPO

(Exclusive Provider Organization) An EPO provides moderate freedom to choose your doctor, and you don’t need a referral to see a specialist, but there is no coverage for out-of-network doctors. And EPO has a lower premium than a PPO. You’ll pay a premium, you may or may not have a deductible, a copay or coinsurance, and unfortunately you’ll pay the full cost of seeing an out-of-network doctor.

POS

(Point of Service Plan) A POS is a mix of an HMO and a PPO. You’ll have more freedom to choose a provider, and have moderate paperwork when going out-of-network. A primary care doctor manages your care and when you can see specialists. With a POS you’ll pay a premium, a deductible, and a copay (which will be higher when out-of-network). When out-of-network you pay a full bill and file claim paperwork to your insurer, and they’ll pay you back.

Catastrophic plan

A catastrophic plan is usually only for people under 30. It has lower premiums, but limited primary care visits before deductible applies. Preventative care is very cheap or free, and you can see any doctor in the plan’s network. However, a lower premium means you’ll have a much higher deductible.

HDHP

(High Deductible Health Plan) To get an HDHP you must first have an HMO, a PPO, an EPO, or a POS. It has higher out of pocket cost until you reach your deductible, and then insurance pays 100% of costs. You’ll pay a lower premium, and a high deductible. Whether or not there’s a copay and paperwork is based on which base plan you use.

HSA

(Health Savings Account) You must be enrolled in and HDHP to have an HSA. It’s similar to bank savings account, but the money is not taxed, and can be used to pay for medical expenses. You have to pay attention to what you personally spend, so you don’t have to pay more than the deductible.

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