Health insurance such as individual, group, or marketplace exchange plans by most major insurance carriers usually come with different levels of benefits, deductibles, and co-pays which will influence the annual premium you will pay.
Basic health insurance plans may have lower premiums and they typically offer fewer benefits with higher max out-of-pocket expenses and deductibles; while plans with higher premiums will typically provide you with less max out-of-pocket costs including copays & deductibles for a wide range of health services.
Health Maintenance Organization (HMO) – HMO plans give you access to a network of doctors and hospitals, and plans may require you to select a Primary Care Physician (PCP). These plans are considered to be more ‘budget-friendly’ as they offer lower premiums. Plans could have low or no deductibles and fixed co-pays for doctor visits. Using a HMO network gives you access to a wide range of medical providers & services, however, there is very little or no coverage should you need to use health providers/facilities outside of the network.
Preferred Provider Organization (PPO) – PPOs provide a greater flexibility level as far as providers/facilities being that you can seek care out of network.
One significant advantage of having a PPO is that you are not required to have referrals from your Primary Care Provider (PCP) to see a specialist.
Typically, these plans come with higher premiums and can have low or no deductibles; co-pays and co-insurance can also be lower.
Exclusive Provider Organization (EPO) – An EPO offers a much more extensive network of care providers than HMOs combined with some plans not requiring referrals to see specialists. The premiums tend to be higher than HMOs but lower than PPOs.
Short Term Medical – STM plans are health insurance plans with a limited duration, typically for several months up to a year or more. These plans are geared towards people who need temporary medical insurance to bridge the gap between longer term plans. These plans can also be used for bridging the gap before a person joins Medicare.
Details for all of these different health insurance plans can be a lot to digest. Fortunately, our experts can guide you through the entire process and help you pick the best plan(s) for you and your family.