In recent years there has been significant changes to the Health Insurance Industry that has affected just about everyone from the plan holders, to the insurance companies themselves.
It can easily get confusing as everything still has to abide by “Obamacare” or the Affordable Care Act, which makes health insurance accessible and affordable to all Americans. These different types of Medical insurances plans are:
- Individual health plans in the form of Obamacare for individuals and families.
- Obamacare plans that are considered Qualified Health plans as the plan holder qualifies for a government subsidy.
- Insurance Plans offered through Employers.
- Catastrophic plans that are mostly offered to younger people that will cover them for extreme medical conditions or accidents that may occur.
- Government Insurance plans such as Medicaid or Medicare.
- Gap Insurance which covers the differences in a procedure you may have that your normal health plan does not cover.
- Short Term Health Insurance.
In America the majority of the population gets its health insurance from private companies or employers where they work. Another large majority that is growing at an extremely fast pace in the Medicare market which is available to people who are retired over the age of 65. With the staggering amount of Baby Boomers reaching age 65 (10,000 per day!) this is a huge market only growing each day.
The ones in poverty are usually issued Medicaid, which is government sponsored, and the remaining ones buy a health plan through a government run marketplace or direct with an agent or online. Obamacare requires all to be insured or pay a tax penalty that is based on your income each year.
(UPDATE: No longer are you penalized at the end of the year for not having Health Insurance )
Each of these plans must meet the criteria for offering minimal coverage. Basically this means that no one can be turned down for Health Insurance. These plans must offer certain treatments and be preventative in nature.
Plans That Are Issued to Americans
HMO – Health Maintenance Organization:
This is by far one of the most popular plans on the market that you can purchase. This has a group of providers that have agreed beforehand to offer its services to you in a network. You do have to select one primary care provider who then coordinates with the other doctors inside this network that provides all your health care services.
Usually the HMO plans offer some sort of service for preventive care and even specialist visits (only when your PCP makes this request). When services rendered are not preventive you will be required to make copayment and you will have a annual deductible to reach before the majority of the services or treatments are covered. You then may have a split of some sort where the Insurance will pay a larger percentage and you a smaller.
PPO – Preferred Provider Organization:
This is a Preferred Provider Organization plan that allows you and your family to see ANY health care provider inside the network including specialist without the need for a referral from a PCP.
In this plan you will have co payments for any non preventive medical care that needs to be addressed as well as having an annual deductible. Because of the costs of these plans, they have seen a significant DECREASE in popularity by Americans.
EPO – Exclusive Provider Organization
With an EPO you have access to all providers within the network including special doctors. EPOs do not offer services outside its network whatsoever unless in some emergency cases.
For those who don’t want a PCP and don’t mind going to doctors in the network this is usually a good fit. This plan has been increasing in popularity as there is less decision making on the plan holders’ behalf.
POS – Point of Service Plans
Sometimes called the combo of a HMO and PPO this plan designates you a PCP where you do regular checkups and referrals. At the same time you can use out of network providers, but it comes at a premium.
You have to be willing to pay more out of pocket while still having a copayment as well as the required deductible to meet. For those willing to pay the extra this plan is one of the more flexible and versatile plans on the market.
HDHP – High Deductible Health Plans
These plans can be a HMO, PPO or even a EPO network. These plans generally come with a high annual deductible you have to meet before the insurance company comes out of pocket and starts paying anything. Those looking to use coverage extensively are usually a good fit.
These plans usually have a HSA account that is attached to them. This allows for money contributed to this account, that is used for qualifying medical services, to be saved pre tax or tax deductible including the annual deductibles.
Short Term Plans
If you missed an open enrollment period, sometimes a Short Term health plan could be a good fit. They are generally issued all year around and at least get you covered in the meantime until the next enrollment period.
These are usually very limited health plans but can be a savior in the event of an unexpected accident or illness. These plans ARE allowed to exclude pre existing conditions. It is a non renewable plan and has no coverage for preventive care.
GAP Insurance
These plans are designed to fill in the holes that may not be covered under your regular medical plan. They are designed to cover the unexpected costs in the case of a medical emergency. They are good even if you don’t have a major medical policy as they still can help cover in the event of a serious health condition, or as mentioned be used as a supplemental force on an existing policy.
These plans cover for accidents that may occur, they can offer cash payouts if you suffer from covered illness or accidents to help you pay for personal bills, etc, and cover critical illness which will payout if you have a heart attack, get cancer, etc.
Conclusion
There is a wide variety of choices for plans, each containing a wide variety of coverages in each. When enrolling take the time to review each plan carefully, finding the ones that best suits the needs for you and or family. Or if you have a specific doctor you are wanting to receive services from, go the back way and ask them what plans cover their services and then choose the best from that category.
Usually an agent, customer service or HR can give you a hand, just be sure and take your time to evaluate the choices.
