Types of Private Health Insurance Plans

There are a variety of private health insurance plans that meet customer needs in different ways. A Health Maintenance Organization, or HMO, is a plan that does not provide coverage outside the network. This status means you can only have coverage for care at the offices of doctors within that network.

An HMO requires you to have a primary care physician, and any specialist visits require a referral. A Health Maintenance Group does provide 100% coverage for preventative care. An HMO requires you to have a primary care physician, and any specialist visits require a referral. The HMO is also a qualified health plan, so it follows the guidelines of the Affordable Care Act. A smaller network, somewhat more expensive, and no medical underwriting are all hallmarks of this type of private health insurance.

An Exclusive Provider Organization (EPO) follows the guidelines mentioned here. It has regional coverage for its network of doctors. It is very similar to the HMO in that it covers all preexisting medical conditions. However, no referrals are needed to see a specialist.

A Preferred Provider Organization plan (PPO) allows a visit with in-network doctors or specialists without a referral from your primary care doctor. They will encourage the use of in-network doctors. That preferred designation means you pay less for a doctor on this list.

The PPO also does not necessarily require you to choose a primary. In-network means the highest level of coverage for the services covered by your company. That coverage is a vital consideration when it comes to saving.

There are also POS or Point-of-Service plans which require you to select a primary care physician. Out-of-network care providers are available at higher costs. Catastrophic plans cover precisely what their name implies. Their coverage is in the event of an injury or illness that results in surgery or extensive repair. It only covers you for those incidents. High-deductible health plans, with or without health savings accounts, are effectively an HMO. Preventative care is covered, and the cost of each visit to the doctor or prescription medication is wholly your responsibility. Outpatient surgery, MRIs, removal of small lesions are all paid for by you and applied to your annual deductible. A follow-up visit means you pay part of the cost.

Ways of Getting Insurance

You can obtain insurance by being on the employer-sponsored plan of your spouse or significant other. The Health Marketplace is also available for shopping around for private insurance plans, in the U.S. You can make cost and coverage comparisons to see what fits for you. There is also online assistance in the marketplace that will help you in the deciding process.

Costs Associated with Insurance

When you decide the plan you want, the obvious question is, “how much will this cost?” It wouldn’t be much of an insurance company if they did not cover some of the costs. The three vital things to think about are the premium, deductible, and out-of-pocket costs or maximums.

Premiums are the recurring cost, usually monthly, for being a member of a plan. There are services like regular screenings for chronic conditions covered under this premium. To have other services, you will pay extra.

The deductible is how much you will pay before your private insurance plan shares in the costs. If you have a $1000 deductible, you will pay for all services until you hit that magic number. It is best to be familiar with the prescription drugs that count towards that deductible.

Once the deductible is satisfied, your costs for services divide between yourself and the insurer. You will pay co-pays and other payments up until you hit the out-of-pocket maximum. Your insurance company pays 100% of your services until the end of the plan year. You won’t pay more than this maximum for the year. A broker will help you choose the plan that fits the needs of you and your family.

Alternative Options for Insurance

A short-term major medical plan is another option. It works for some young people who make infrequent visits to the doctor. It is also a consideration of those who rarely need medical care. If you had a condition that needed regular visits, are pregnant, or were recently pregnant, this is not likely to be the plan for you.

It allows for a short-term 12-month plan that is up for renewal after 36 months. The insured would then reapply and seek coverage for the next period. These are different from employer-provided group plans and marketplace plans. Still, these short-term plans are a fit for millions in the United States. They are no longer just for specific circumstances due to changes in lifestyle that could’ve created a coverage gap, such as changing jobs.

If you are eligible, then you can save a substantial amount of money each month. Eligibility is, of course, the prime question. Work with your broker to be sure a plan meets your needs. In addition to savings, there is often coverage nationwide. You would not see this option with a PPO.

A point of note is that they do not meet the care act guidelines. There is medical underwriting which requires an eligibility questionnaire. Coverage hinges on where you fall in their eligibility guidelines.

The short-term plan has the same benefits as a marketplace plan. The cost is what makes up a considerable bit of the difference. As it is more exclusive because of underwriting, it can be less expensive than other choices.

Enrolment is also possible for these plans at any point. No open enrolment period is needed. Choosing a broker is just one of the choices for how to start your coverage under the short-term medical plan.

If you need maternity care, or you are looking for plans that qualify for tax credit savings, then shop around. There is no one size to fit all. Have a look around and partner with a professional broker that can steer you on the right track.

Being covered is invaluable.