Understanding the 4 Types of Health Insurance

October 28, 2020

Understanding the 4 Types of Health Insurance

Although looking for the right health insurance plan can be a hassle, the good news is that you have options. There are different types of marketplace health insurance plans designed to meet the various needs of patients. Some plans offer flexibility when choosing your provider. Others are more focused on saving you money on healthcare costs.

Whatever plan you choose, you may want to speak with a health insurance broker before getting an insurance plan. A broker can assess your current situation, match you with the right health insurance company, and help you save time and money finding a health insurance plan that works for you. They can also guide you through the process to save you time and energy.

Exclusive Provider Organization (EPO)

An EPO is a managed care plan where healthcare services are covered by the insurance company only if you use primary care physicians, treatment specialists, or health facilities in the insurance company’s network. However, an EPO typically costs you less than an HMO or a PPO with lower healthcare rates.

Your policy does not cover any provider outside of the EPO. However, if you know what type of insurance you need, getting coverage is easy, and you do not have to provide referrals for your providers. An EPO is ideal if you do not have medical problems and do not require a lot of medical treatment.

Health Maintenance Organization (HMO)

Perhaps the most popular type of insurance plan is an HMO. An HMO limits coverage to doctors who work for or contract with the HMO. As such, treatment may not get covered if the doctor is out of the network unless you have an emergency. You may also need to live and work in the service area under an HMO.

A benefit of an HMO is that it provides integrated care with a focus on wellness and prevention. Plus, you are more likely to save money with lower premiums. Keep in mind that HMOs require that all healthcare services be coordinated through your primary care physician. So, if you get sick, you need to see your family doctor who will refer you to a treatment specialist in the HMO network.

Point of Service (POS)

A POS is a type of health insurance plan where you pay less for treatment if you use doctors, specialists, or healthcare facilities within the network. However, you do have the option of going out of the network to choose your own doctor. If you do, you may pay higher out-of-pocket expenses.

This type of plan is a hybrid between an HMO and a PPO plan. It is possible to refer your doctor to the network. Doing so can save you money on treatment. The only real downside to a POS is that you must file all the paperwork when you visit a provider that is not in the network.

Preferred Provider Organization (PPO)

A PPO gives you more freedom to choose your provider than any other type of health insurance plan. You do not have to stay in the insurance company’s network or get a referral for treatment. You can choose which physician you want to see, and the health insurance company will pay a portion of the treatment.

However, if you go out of the network, you will likely pay substantially more for treatment services. You may also pay higher premiums in a PPO. Unlike an HMO, a PPO may not provide benefits or coverage for preventative care.

Which Health Insurance Plan is Best for Me?

You may be wondering which health insurance company is the best? When choosing a plan, you first need to assess your personal healthcare needs, look at all your options, and choose a health insurance plan that fits in your budget. How do you determine which health insurance is best? Ask yourself these questions:

How often do you visit your doctor?
What type of treatment do you need in the next 12 months?
What prescription drugs do you currently take?
Which healthcare providers/physicians do you prefer?

Once you decide your healthcare needs, you can narrow your search to health insurance companies in your state. Some of the health insurance providers that we work with include:

A Health Insurance Solution That Makes Sense

We leverage what you pay for medical services. You end up paying much less than what insurance companies pay out.
We negotiate procedures and services from healthcare providers and treatment facilities within Multi-Plan on your behalf. If you are self-paying, you save up to 80 percent when you use a provider in the network.
PHCS Multi-Plan is the largest healthcare PPO network in the country.
You choose any doctor in the network.
Our plans pay out benefits based on all benefits schedules regardless if the benefit exceeds your discounted price. You simply pay the remaining balance.
Use Healthcare Bluebook, a simple online tool, to help you find the best care and price for your procedure in your local area.

We Offer Affordable Health Insurance in These States:

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Contact Insurance Enterprise for Premier Health Insurance

If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.