Types of Health Insurance Plans
When considering health insurance, several factors come into play. Flexibility, cost, coverage attributes, and increased liability are all important considerations. Depending upon a selected provider, both individuals and families can access a variety of health insurance options.
Within the health insurance industry, several types of health insurance plans exist. A Preferred Provider Organization (PPO) plan, while moderately expensive, is incredibly flexible. Meanwhile, HMO plans provided through a Health Maintenance Organization are relatively affordable. However, HMO plans are quite inflexible.
Several other plans, such as Point of Service (POS) plans, directed towards network-physician advisors, and the Affordable Care Act (also referred to as ObamaCare), which provides individuals with affordable, overarching care, are available. Each type provides different ranges of accessibility and affordability and each carries its own price based on family size and individual income. Short-term, Executive Provider Organization (EPO) and Health Savings Accounts (HAS) plans are available, too, and are unique depending upon an individual's financial and medical needs.
Individuals acquiring health care coverage through a Health Maintenance Organization typically get a certified HMO physician for primary health concerns. These doctors carry a slew of benefits for both individual and family health insurance options including:
- Industry-maintained professionalism
- Coordinated medical care
- Provision of specialist and referral treatment
HMO physicians similarly coordinate cardiologists, dermatologists and surgeons. Those seeking treatment from external physicians, however, are often required to pay their own expenses. Typically, an HMO cannot require referrals for an individual's emergency care.
Preferred Provider Organizations are considerably flexible when compared to traditional HMO providers. While PPO plans are coordinated through a specified list of hospitals and physicians, they often carry a higher healthcare cost, though individuals may visit "out-of-network" providers.
However, PPO plans often require co-insurance payment of external providers, as the insurance company normally doesn't negotiate discount rates. Normally, those extending options from a PPO network must follow several procedures:
- Provision of receipt from external provider
- Full payment of out-of-network provider service time
- Provide partial reimbursement to providers
- Produce a referral for specialist treatment
Point-of-Service options combine HMO and PPO plans. Individuals are often required to designate pre-specified network physicians for primary health care, and out-of-network options are available provided costs are paid.
Where specialists are considered, POS plans normally pay the individual or family's bill. Depending upon the area's medical network, a POS plan is an ideal selection for the following groups:
- Small businesses
- Large families across multiple locations
- Frequent travelers
POS options are incredibly versatile making them ideal for those accessing multiple medical establishments. Commonly, businesses offer POS plans due to their diversity.
Executive Provider Organizations cover a multitude of services provided through health care professionals. Often, these services are signed with insurers, making it similar to PPO insurance plans.
Under EPO plans, individuals and families are ensured low-cost medical care from PPO network providers. EPO plans are good alternatives for those seeking PPO plans while requiring additional flexibility:
- EPO plans cover out-of-network-care-coverage
- No health care provision coverage required
- Low cost
Affordable Short-Term Insurance Plans
Within the health insurance marketplace, short-term insurance plans are a common purchase. Unlike the above plans, short-term insurance plans are obtained through policy exchangers, which typically offer affordable "safety nets" for individuals and families without organization-provided plans. Many individuals in the following situations often get short-term insurance plans. They include:
- Unemployed individuals
- Families transitioning between plans
- Recent college graduates
- Divorced individuals
- Retired individuals
Short-term insurance is not regulated through the Affordable Care Act, and it is available year-round. Short-term insurance covers emergency care, though they don't cover pre-existing conditions, as HMO, PPO and POS plans do.
A Health Savings Account is available for individuals participating in health programs featuring high deductibles. Those opting for HAS benefits are often heavily taxed when placing their pre-tax income within a health care expense account.
HSA plans, while fiscally responsible, may be complicated to acquire, and they may be difficult to maintain for those with unsteady taxes. These plans are acquirable through traditional health plans as an extension, and are available depending upon individual health plans.