Finding the health insurance plan that is right for you takes some research and a bit of careful consideration. Choosing a health care plan does not have to be as stressful or confusing as it can sometimes appear to be. Becoming familiar with the different sorts of health plans that are available to you and your family is the first step to figuring out what might be the best plan for you and your family.
Learning about the different coverage levels associated with the health insurance plans available in your state’s health care marketplace will also make it easier to be able to find the one that best suits your needs. Even more, understanding what your priorities are when it comes to your health care plan will shed light on which plan is best for you. Read on to discover key information about how to find the right health insurance plan for you and your family.
Common Types of Health Insurance Plans
It will be impossible to figure out which health insurance plan is ideal for you if you are not aware of the various types of insurance plans you have to choose from. While your unique medical and household needs will dictate exactly what health insurance programs you may be eligible for, most people will likely be choosing from the most common forms of health insurance plans when shopping at their state’s health insurance marketplace.
The most popular health care plans available in most states are detailed below:
- Health Maintenance Organizations (HMOs) are established networks of health care providers and facilities that work on a referral system. HMO enrollees must visit their primary care doctors to receive a recommendation to see a specialist and will only receive coverage for doctors and facilities within the established network. Although HMOs offer little freedom, they also are some of the simplest health plans available and thus require very little paperwork on the program participant’s side.
- Preferred Provider Organizations (PPOs) are health care plans that allow enrollees to visit specialists without a referral from their primary care doctor and include coverage for out-of-network doctors and facilities, though usually at a steeper premium or deductible rate. As a result, PPOs offer more freedom to choose than HMOs but often higher costs and more paperwork if seeing out-of-network health providers.
- Exclusive Provider Organizations (EPOs) are health insurance plans that are similar to PPOs in that they offer enrollees freedom to choose and visit medical specialists without a referral from their primary care physicians, but they are different from PPOs in that participants in EPOs will not receive coverage for seeing out-of-network doctors (unless in an emergency situation).
- Point-of-Service Plans (POS) provide health insurance options to people who would like to be able to choose their doctors and health care facilities but at lower costs than many other types of health insurance plans. Enrollees in POS plans have to see a primary care physician to be referred to specialists and must fill out more paperwork for visiting out-of-network medical providers than for in-network providers.
- High-Deductible Health Plans with or without a Health Savings Account (HDHPs/HSA) are health care plans that work great for low-risk individuals who are looking for basic coverage for serious medical emergencies, similar to the Catastrophe Health Plan for adults younger than 30 years of age. Enrollees in HDHPs usually work within a structure similar to HMOs but pay less for the annual premium and more for medical service deductibles before reaching the 100 percent coverage minimum. HSAs are tax-free savings accounts that can be used to pay for these high deductibles.
- Fee for Service (FFS) plans are a bit less common but still the best choice for some people. FES health plans allow enrollees complete freedom to choose their preferred doctors and medical facilities without limitations, paying a set amount for each service. FES health insurance plans are generally more expensive than other plans.
Coverage Levels for State Health Insurance Marketplace Programs
All of the aforementioned health care programs are available at various coverage levels, depending on the insurance provider in question. In most cases, these coverage levels are divided by the percentage of medical costs covered by the plan and the percentage paid by the enrollee, referred to as bronze, silver, gold, and platinum.
Some plans, like Catastrophic Health Insurance Plans and Family Health Insurance Plans, are significantly different than the other coverage levels and are applicable for only certain eligibility groups. Making sure you understand what each coverage level offers you is the best way to ensure that you are choosing the health plan that will best suit your needs.
Most health insurance plans you will find in your state marketplace will be offered with the following coverage options:
- Platinum Health Insurance Plans pay an average of 90 percent of your medical costs, while you pay 10 percent.
- Gold Health Insurance Plans pay an average of 80 percent of your medical costs, while you pay 20 percent.
- Silver Health Insurance Plans pay an average of 70 percent of your medical costs, while you pay 30 percent.
- Bronze Health Insurance Plans pay an average of 60 percent of your medical costs, while you pay 40 percent.
- Catastrophic Health Insurance Plans pay less than an average of 60 percent of your medical costs and provide full coverage for an enrollee’s first three primary care visits and other preventive health care. Most health insurance providers offer this type of insurance to enrollees younger than 30 years of age.
- Family Health Insurance Plans are umbrella health care plans that cover entire households, usually up to two parents and four children without additional costs. Coverage amounts and out-of-pockets vary significantly among family health insurance plans according to included services, provider network, number of family members enrolled and more.
Consider Your Health Insurance Options and Needs
Once you understand how the most common health care plans work and what coverage levels are available to you, it is important to begin considering what your highest priorities are when it comes to your health care coverage. Each type of health insurance plan offers different benefits to enrollees that prioritize various aspects of health care packages.
You may be able to figure out which health insurance plan is right for you by identifying which aspect is the most important to you. Consider which health insurance plan may be best for you by recognizing which plan prioritizes the same health care features you do. Applicants with the following health care priorities may want to consider signing up for insurance plans with similar priorities:
- Lower Upfront Costs: If you are most concerned about finding affordable health insurance, HMOs are usually the most economic health insurance plans available in state marketplaces. If you are part of a low-risk group and do not expect to have any significant medical needs in the near future, you can choose an HMO at the Bronze or Catastrophic Protection levels to pay the lowest regular premiums. However, any surprise medical problems can end up being costly with these programs due to their higher out-of-pocket costs.
- Lowest Deductible or Copay: If you would like to exchange a higher monthly or annual premium for paying lower deductibles or copays for every visit or service, avoid choosing POS plans and FFS plans, all of which tend to have higher out-of-pocket costs. Look into choosing the best health care plan at the Platinum coverage level.
- Healthy Adults Younger Than 30: If you are in good health and do not expect your status to change any time soon, you can consider signing up for a Catastrophic Health Insurance Plan that will cover most preventative care visits and medical care for emergencies or chronic illnesses. These health insurance plans are usually available at significantly lower costs than other more comprehensive health insurance plans.
- Family Coverage: If you would like to purchase medical insurance for your spouse, children or other tax-dependents, look into buying a Family Health Insurance Plan. Family plans group the health insurance needs of multiple family members into one plan, making it significantly easier and often cheaper for families to have comprehensive health insurance for all family members.
- Freedom to Choose Providers: If you would like to have the most freedom possible to choose your medical providers and facilities, the less-common FFS insurance plan may be right for you. PPOs, POS plans and HDSPs also offer partial coverage for seeing out-of-network health care professionals at lower costs than the average FFS.
- Less Paperwork: If you are most concerned about having good medical coverage with as little hassle as possible, you will most likely be happiest with an HMO, EPO or other health insurance plan with an established network provider list that permits enrollees to receive services without filing any claim forms.