Let’s Compare Different Healthcare Plans
There are few healthcare plans to choose from when buying the insurance from your state’s Marketplace or an insurance broker. They differ in the level of benefits they offer—they can be bronze, silver, gold, and platinum. But this is only the first division.
As you can probably assume, bronze plans have the least coverage, and platinum plans have the most. There is also an option for people under 30 to buy a high-deductible, catastrophic plan.
In a nutshell
Platinum plan covers about 90% of your medical costs while you pay only 10%; gold plan covers about 80% of your medical costs while you pay only 20%; silver plan covers about 70% of your medical costs while you pay only 30%; bronze plan covers about 60% of your medical costs while you pay 40%.
As for the catastrophic policies – they pay less than 60% of the total average cost of care. They also cover the first three primary care visits and preventive care for free regardless of the fact whether you have met your deductible or not.
There are also different insurance brands to choose from, and these are associated with the care levels – Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.
Depending on your health care preferences, you may choose between these four particular types of plans:
- —Health maintenance organizations (HMOs)
- —Preferred provider organizations (PPOs)
- —Exclusive provider organizations (EPOs)
- —Point-of-service (POS) plans
- —High-deductible health plans (HDHPs), which may be connected to the health savings accounts (HSAs)
Let’s now learn about these detailed plans.
Health Maintenance Organization (HMO)
With this plan, there is the least paperwork required but also the least freedom to choose a healthcare provider. You can visit only doctors in your HMO’s network. If you wish to see a doctor who is not part of the network, you will have to pay the whole bill by yourself. All the emergency services done at the hospital that is out of the HMO’s network must be covered at the rates given for hospitals that are part of the network. Still, doctors who treat you in this out-of-network hospital cannot bill you by this plan if they are out of the network.
With an HMO, you can have a primary care doctor to manage your care. If necessary, he will refer you to specialists and this care will be covered by the health plan. A referral to a specialist is a must.
Preferred Provider Organization (PPO)
With a PPO, you will have a bit of paperwork if you want to see a doctor who is out of your PPO network since you have to file a claim for that service to get the PPO plan to pay you for it. With this plan, there is a moderate amount of freedom when it comes to choosing your health care provider. Still, there is more freedom than with the HMO plan. On the other hand, with PPO you do not have to get a referral from a primary care doctor to see a specialist, which is sometimes a better and a time-saving option.
If you want to see a doctor who is out of PPO network, you will have to pay more than the basic amount. Also, as we have already mentioned, there is more paperwork included when you decide to take the service from seeing out-of-network providers.
Exclusive Provider Organization (EPO)
EPO is to some extent similar to PPO since here you also have a bit of freedom to choose your healthcare providers and you also do not have to get a referral from a primary care doctor to see a specialist. But in contrast to PPO, with EPO you don’t have coverage for out-of-network providers. If you decide to see a provider that is not in EPO’s network – emergency excluded – you will have to pay the full cost of the treatment from your own pocket.
What is good with this plan is that there is a lower premium than a PPO offered by the same insurer.
So to conclude, with an EPO you can see any doctor who is in the EPO network, and there is no paperwork included since your visit to out-of-network providers will not be paid for.
*Generally for all the plans – your in-network-services do not require paperwork, just those which are done out-of -network when you need a refund from your plan. If a plan offers it.
Point-of-Service Plan (POS)
A POS plan combines some characteristics of an HMO with a PPO. Here you have more freedom to choose your healthcare providers, and also there is a certain amount of paperwork if you go to see out-of-network providers. With POS plan you have a primary care doctor who coordinates your care and if necessary, refers you to specialists. So, basically, with POS you can see in-network providers your primary care doctor refers you to or out-of-network doctors, but then you’ll have to pay more.
The paperwork is necessary when you go to an out-of-network doctor since you have to submit a claim to your POS plan to pay you back.
This plan is for people under the age of 30. Here, they get a lower premium plan, three primary care visits before the deductible applies and a free preventive care even if you the deductible haven’t been met. With a catastrophic plan, people under 30 can see any doctor in the plan’s network and also some individual plans may have additional rules on specialists. Also, this person has to keep track of all his medical expenses before he meets the deductible.
High-Deductible Health Plan With (HDHP) or Without a Health Savings Account (HSA)
This plan is similar to a catastrophic plan since you may be able to pay less for your insurance. Here you can choose one of the mentioned types of health plans: HMO, PPO, EPO, or POS, but there are higher out-of-pocket costs than in other types of plans. Still, if you reach the maximum out-of-pocket amount, the plan pays 100% of your care.
As for the health savings account (HSA), the money you put in it is not taxed and can be used tax-free for eligible medical expenses. But if you want to have an HSA, you must first get an HDHP.
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