If you’re shopping for medical insurance, you might be overwhelmed by the number of health insurance plans available. One of the biggest challenges of picking health coverage is understanding what each plan covers. The various acronyms, e.g., HMO, POS, PPO, EPO, only make it more confusing. But, knowing the best option for you can reduce your out-of-pocket costs and help you manage your medical care needs.
Here’s a health insurance quick reference guide to get you started.
Preferred Provider Organization (PPO)
Of all the managed care plans, a PPO offers the most flexibility. The program isn’t strict with out-of-network services. You can also see a medical specialist without a referral from your PCP. You usually pay a higher premium and must pay a deductible with a PPO plan.
Health Maintenance Organization (HMO)
HMO plans typically offer monthly premiums lower than other managed care plans. They may require you to pay a higher deductible and limit the services you receive to a smaller network of doctors and hospitals. The primary care provider (PCP) you select will coordinate the medical care you receive.
Point of Service (POS)
With POS plans, you must pick a PCP like you would with an HMO. To seek additional treatment, your PCP can refer you to another doctor or specialist. Choosing an out-of-network provider is possible with a POS plan. Still, you’ll pay higher medical costs than if your services were in-network.
Exclusive Provider Organization (EPO)
An EPO gives members a choice within a network of medical professionals and facilities. It’s similar to an HMO, though an EPO doesn’t require you to go through a PCP to receive medical services. Medical visits typically require pre-authorization, unless it’s an emergency. An EPO won’t cover any care you receive from an out-of-network provider.
Individual Plans from the Affordable Care Act (ACA)
ACA plans are available through the Health Insurance Marketplace in four tiers:
Categories range in price based on your medical needs. For example, bronze has the lowest monthly premium but comes with a higher deductible. It’s an excellent choice for relatively healthy individuals. Platinum has the lowest out-of-pocket costs for treatments but has the most expensive monthly premium of the plans.
Medicaid Managed Care Plans
Each state offers its own Medicaid managed care plan to provide medical care for people with limited financial resources. You can apply for benefits any time your state allows, even if it’s outside of an open enrollment period.
High Deductible Health Plan (HDHP)
A high deductible health plan is just like it sounds: a type of health insurance that has a more substantial deductible compared to other health insurance plans. While you might pay more for treatment with an HDHP, the premiums are often lower. Plus, you can tap into the tax benefits of a health savings account (HSA) and pay for medical services with pre-tax dollars with an HDHP.
Fee-for-service health insurance plans, or a traditional indemnity plan, don’t limit you to a network of medical providers. Instead, you have the freedom to choose where you get your medical care. The program doesn’t make you select a primary care doctor, which means you can refer yourself for specialist appointments.
Which health plan should I choose?
How much you pay out-of-pocket can play a significant role in the healthcare plan you choose. You might enjoy the freedom of a fee-for-service plan or prefer the lower costs of an HMO. It depends on your needs and preferences.
Prince George’s Community Federal Credit Union has partnered with TruStage Health Insurance Program
to make finding affordable health insurance easy. Use this valuable resource to compare plan services, premiums, and deductibles to find one that fits your needs and your budget. Receive expert advice from licensed agents online or by phone. Get an online quote
or call 888.416.2166 today!