Different Types of Health Plans: How They Compare

1. Health Maintenance Organization (HMO)

2. Preferred Provider Organization (PPO)

3. Exclusive Provider Organization (EPO)

4. Point-of-Service Plan (POS)

5. Catastrophic Plan

6. High-Deductible Health Plan With or Without a Health Savings Account

When you look for health insurance, you have options. You can choose from health plans categorized into bronze, silver, gold, and platinum depending on the level of benefits they offer if you purchase through your state's Marketplace or an insurance broker. Platinum plans offer the most coverage, while bronze plans offer the least. You can also buy a catastrophic plan with a high deductible if you are under 30.

In what ways do the plans differ? Each one contributes a specific amount toward the average enrolled person's costs. Programs can vary in the specifics. Additionally, deductibles—the sum you must pay before your insurance covers 100% of your medical expenses—vary by plan, typically with the least expensive having the highest deductible.

Platinum: Covers 90% on average of your medical costs; you pay 10%

Gold: Covers 80% on average of your medical expenses; you pay 20%

Silver: Covers 70% on average of your medical expenses; you pay 30%

Bronze: Covers 60% on average of your medical expenses; you pay 40%

Catastrophic: After you've met a very high deductible ($8,700 in 2022), devastating policies begin to pay. Even if you still need to reach your deductible, catastrophic plans must pay for the initial three primary care visits and any necessary preventive care.

Along with the care levels, insurance brands will be visible. Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United are well-known national brands.

These five popular types of plans may be offered by one or more insurance companies:

• 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 linked to health savings accounts (HSAs)

Learn the differences between these plans for a moment. Knowing the different plan types will make choosing one that fits your needs and budget easier. Look at the list of benefits in a brand's health plan if you want more information.

1. Health Maintenance Organization (HMO)

An HMO offers all types of medical services through a network of healthcare facilities and providers. An HMO may provide you with:

The least freedom to choose your health care providers

The least amount of paperwork compared to other plans

For the care to be covered by the health plan, you need a primary care physician to oversee your care and refer you to specialists as needed; most HMOs will require a referral before you can see a specialist.

Which physicians are available? Any in the network of your HMO. You might be responsible for paying the entire bill if you visit a physician not covered by the network. Although non-participating doctors who treat you in the hospital can bill you, emergency services at an out-of-network hospital must be protected at in-network rates.

What you pay:

• Premium: You pay a premium each month to obtain insurance.

• Deductible: Other than preventive care, your plan may require paying the specified sum before receiving care.

• Copays OR Coinsurance: Each type of care may have copays or coinsurance. A copay is a set amount, such as $15, that you must pay at the time of service. When you co-insure, you pay a % of the costs associated with your care, for instance, 20%. These fees differ based on your plan and contribute to your deductible.

• Paperwork Involved: No claim forms need to be completed.

2. Preferred Provider Organization (PPO)

With a PPO, you may have:

You have more freedom than with an HMO to choose your healthcare providers, and you can see a specialist without a referral from your primary care doctor.

When compared to in-network providers, out-of-network doctors will cost you more out-of-pocket.

If you visit out-of-network providers, there is more paperwork than with other plans.

Which physicians are available? You can see a doctor not in the PPO's network, but the cost will be higher.

What you pay:

• Premium: You pay a premium each month to obtain insurance.

• Deductible: A deductible may be present in some PPOs. If you visit a doctor not in your insurance's network, your deductible will probably be higher.

• Copay or coinsurance: A copay is a set amount, such as $15, that you must pay at the time of service. When you co-insure, you pay a % of the costs associated with your care, for instance, 20%.

• Other expenses: After your insurance has deducted its portion, you may still be responsible for the difference if your out-of-network doctor charges more than others in the area.

• The paperwork involved: If you visit a doctor in-network with the PPO, there must be more paperwork. You must pay the provider if you use an out-of-network service. Afterwards, you must submit a claim for the PPO plan to reimburse you.

3. Exclusive Provider Organization (EPO)

With an EPO, you may have:

It gives you more freedom to choose your healthcare providers than an HMO, and you can see a specialist without a referral from your primary care doctor.

There is no coverage for out-of-network medical professionals; if, besides, in an emergency, you visit a doctor who does not participate in your plan's network, you are responsible for covering the entire bill.

Reduced cost compared to a PPO provided by the same insurer, for whom physicians are available. Any providers in the EPO's network and out-of-network are not covered.

• Premium: You pay a premium each month to obtain insurance.

• Deductible: There may be a deductible for some EPOs.

• Coinsurance OR Copayment: A copay is a set amount, such as $15, that you must pay at the time of service. Coinsurance is when you pay a % of the costs associated with your care, for instance, 20%.

• Other Expenses: If you visit an out-of-network provider, you must pay the total amount.

• Paperwork Involved: With an EPO, there needs to be more paperwork.

4. Point-of-Service Plan (POS)

A POS plan combines aspects of an HMO and a PPO. With a POS plan, you could:

You have more freedom than in an HMO to choose your healthcare providers.

If you see out-of-network providers, there will be some paperwork.

A primary care physician who coordinates your care and makes specialist referrals for you

Which physicians are available? Your primary care physician may refer you to in-network healthcare professionals. Out-of-network doctors are available, but the cost will be higher.

What you pay:

• Premium: You pay a premium each month to obtain insurance.

• Deductible: Before providing care beyond preventive services, your plan may require you to pay a certain amount as a deductible. If you visit a provider not in your network, your deductible might be higher.

• Copays OR Coinsurance: You will either pay a copay, such as $15, or coinsurance, a percentage of the cost of care when you receive treatment. When you visit an out-of-network physician, your copayment and coinsurance will increase.

• The paperwork involved: In this case, you are responsible for the cost of your care. You then submit a claim for payment to your POS plan.

5. Catastrophic Plan

You can purchase a catastrophic health plan if you're under 30. A disastrous health plan may include the following:

Lower Premium

Three office visits before the deductible is charged

Free preventive care, even if the deductible hasn't been met

and physicians are available. Any in-network-specific plans may have more restrictions on specialists.

What you pay:

• Premium: You pay a premium each month to obtain insurance.

• Deductible: In 2022, a catastrophic health plan's deductible will be $8,700 for single people and $17,400 for families. Once you have met that deductible, the program will cover 100% of your medical expenses for covered benefits.

• You were involved with paperwork: You should keep track of your medical costs to demonstrate that you have met the deductible.

6. High-Deductible Health Plan With or Without a Health Savings Account

You can pay less for your insurance with a high-deductible health plan (HDHP), similar to a catastrophic plan. You might have an HDHP if you:

HMO, PPO, EPO, or POS are some of the health plan types available.

Higher out-of-pocket expenses than many other plans; like other projects, the program will cover all your medical expenses if your out-of-pocket costs reach the maximum.

A health savings account (HSA) to aid in financing your care; funds deposited into an HSA are not subject to tax and may be used tax-free for qualifying medical costs. You need to be signed up for an HDHP to have an HSA.

Depending on the deductible, many bronze plans might be eligible for HDHPs (see below).

What doctors can you see? This varies depending on the type of plan -- HMO, POS, EPO, or PPO.

What you pay:

• Premium: An HDHP typically has a lower premium compared to other plans.

• Deductible: In 2022, the deductible will not exceed $7,050 for an individual and $14,100 for a family. It will be at least $1,400 for individuals and $2,800 for families. Like all plans, your preventive care is covered even if the deductible has yet to be reached.

• Coinsurance or copayments: When seeking medical attention, you must cover all expenses up to your deductible aside from preventive care. To cover these expenses, you can use funds from your HSA.

You can create a Health Savings Account to assist with financing your expenses. In 2022, the most you can put into an HSA is $3,650 for single people and $7,300 for families. If you are 55 or older, you may contribute an additional $1,000.

You were involved with paperwork. Keep all your receipts to access your HSA and determine when your deductible has been satisfied.