Health Insurance Plans: A Complete Guide

Don’t we all love to have different options in our hands?

And that’s what you get when you go out looking for the perfect health insurance plan for you and your family. 

Usually, you’d buy a health insurance plan from an insurance broker or your state’s Marketplace. 

And that’s when you will have a whole lot of different options in your hands to choose from. 

Let’s take a look at how the plans are arranged on the Health Insurance Marketplace:

  • Bronze
  • Silver
  • Gold
  • Platinum

You may choose a health plan accordingly from any of these on the Health Insurance Marketplace. 

If you choose a bronze plan, the coverage that you’ll get is the least comparatively.

While it’s the highest in platinum.

Is your age less than 30?

Well, GOOD NEWS!  You may even be able to buy a high-deductible, catastrophic plan. 

Confused how these plans work? Want to know how they are different from each other? 

Don’t worry! That’s precisely what we are here to help you with.

Let’s learn what these plans individually have to offer:

Let’s begin with platinum.

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Platinum

If you choose to buy a platinum plan, 90% of your medical costs are covered on an average. 

The remaining 10%. That’s what you’ll have to pay from your own pocket. 

Gold

If you choose to buy a gold plan, 80% of your medical costs are covered on an average. 

The remaining 20%. That’s what you’ll have to pay from your own pocket. 

Silver

If you choose to buy a silver plan, 70% of your medical costs are covered on an average. 

The remaining 30%. That’s what you’ll have to pay from your own pocket.

Bronze

If you choose to buy a bronze plan, 60% of your medical costs are covered on an average. 

The remaining 40%. That’s what you’ll have to pay from your own pocket.

Catastrophic Plans

Here, you get paid after you’ve reached a high deductible. 

However, there’s good news!

Even if you haven’t met the deductible, catastrophic plans will entirely cover the first primary and preventive care visits for free.

Can you name some of the most famous health insurance brands?

Don’t worry! These are the ones you need to know about:

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  • Aetna
  • Cigna
  • Blue Cross Blue Shield
  • Kaiser 
  • United
  • Humana

You’ll see the different levels associated and offered by each of these brands.

Each of the brands may offer you one or even more than one kind of plans:

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  • Health Maintenance Organization (HMOs)
  • Preferred Provider Organization (PPOs)
  • Point of Service (POS)
  • Exclusive Provider Organizations (EPOs)
  • High-Deductible Health Plans (HDHPs)

Well, that’s a lot of names right there.

Don’t worry! We don’t want to leave you all confused.

In this blog post, we will take a look at what these plans are precisely and how they differ from each other.

Let’s get rolling.

Health Maintenance Organization (HMOs)

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An HMO will provide you all of the health services through an entire network of healthcare facilities and providers. 

Let’s learn what you may have:

  • Least amount of Paperwork
  • Least freedom to choose your healthcare providers
  • A primary doctor that will manage your care. Plus, the doctor may even refer you to a specialist if you need one. However, most HMOs will need a referral before you go visit a specialist.

Which Doctors Can You Visit?

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You can visit any of the doctors within the HMO’s network.

If you choose to visit a doctor out of the network, then you won’t be paid a single penny from the Health Insurance plan. You’ll have to pay the entire bill by yourself. 

What Will You Have To Pay?

You need to pay the following:

  • Premium
  • Deductible 
  • Copays as well as co-insurance for each kind of care

Premium

That’s the cost that will pay each and every month for the insurance.

Deductible

Before your plan covers for the care, you’ll be required to pay a certain amount, depending on your plan. That’s what deductible is.

However, preventive care isn’t included and does not count towards the deductible. 

Co-pays/ Co-Insurance

What’s a copay?

That’s the fee you need to pay when you get care.

What’s a co-insurance?

That’s the percent of the care charges. 

Co-insurance varies according to the plan you choose. 

Is There Any Paperwork Involved?

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You won’t be required to file a claim form.

Preferred Provider Organization (PPOs)

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Let’s learn what you may have with a PPO:

  • You will have a moderate amount of freedom when it comes to selecting a health care provider. The liberty will undoubtedly be more when you compare it with HMO.
  • Want to see a specialist? You won’t require a primary care doctor’s approval. 
  • Higher costs comparatively.
  • More Paperwork comparatively (If you choose to visit an out-of-the-network provider)

Which Doctors Can You Visit?

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You can visit any doctor within the PPO’s network. 

You can even visit out-of-the-network doctors as well. However, you’ll have to pay more comparatively.

What Will You Pay?

You need to pay the following:

  • Premium
  • Deductible 
  • Copays/ Co-insurance
  • Other fees

Premium

That’s the cost that will pay each and every month for the insurance.

Deductible

Some of the PPOs will have a deductible that you need to pay. 

If you choose to visit an out-of-the-network doctor, then you’ll have to pay a much higher deductible. 

Co-pays/ Co-insurance

That’s the same as in HMO.

Other Costs

The chances are that the out-of-the-network doctor that you choose to visit charges you more than the in-network doctors.

In such cases, you are required to pay the balance that’s left after the insurance pays its share. 

Is There Any Paperwork Involved?

Little to no paperwork’s involved. 

However, that’s true only in case you go with an in-network doctor. 

If the doctor that you visit is an out-of-the-network one, then you will have to pay. Afterward, you are required to file a claim. And that’s how you get the PPO plan to pay you back.

Point Of Service (POS)

Image result for point of service plan

A perfect combination of the features of HMO and PPO.

That’s what a Point of service plan is. 

In case of a PPO plan, you may have:

  • More freedom to choose a health care provider than in an HMO
  • A moderate amount of Paperwork (Only if you decide to visit an out-of-the-network provider)
  • A primary doctor who will be responsible for managing your care. The doctor will refer you to a specialist when needed.

Which Doctors Can You Visit?

Your primary care doctor will refer you to an in-network doctor whenever required. You can even visit an out-of-the-network provider by yourself. However, you’ll have to pay more in such cases.

What Will You Pay?

  • Premium
  • Deductible 
  • Co-pays/ Co-insurance

We discussed all of these concepts in the above plans. 

Is There Any Paperwork Involved?

If you decide to visit an out-of-the-network doctor by yourself, then you will have to pay the fees.

However, you can always apply for a claim and get a certain percentage of your money back.

Exclusive Provider Organization (EPO)

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Let’s learn what you may have with an EPO:

  • You’ll have a moderate amount of freedom when it comes to choosing a health insurance provider. You’ll have more freedom than you’ll get in HMO. 
  • You won’t require a referral from your primary care doctor to visit a specialist. 
  • You won’t be paid anything back if you decide to visit an out-of-the-network provider. However, that’s not the case in an emergency. 
  • Comparatively lower premium than the PPO from the same insurer. 

Which Doctors Can You Visit?

You can visit any doctor in the EPO’s network. You won’t be paid any coverage if you visit an out-of-the-network provider. 

What Will You Pay?

You need to pay the following:

  • Premium
  • Deductible 
  • Co-pays/ Co-insurance
  • Other fees

Is There Any Paperwork Involved?

Little to no paperwork is involved in the case of an EPO.

High-Deductible Health Plans (HDHPs)

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In case of a health-deductible health plan, you’ll have to pay less for the insurance. 

With an HDHP, you are subject to:

  • Any of the following: HMO, PPO, EPO, POS
  • Higher out-of-the-pocket costs comparatively. The plan will pay 100% of your care if you reach the maximum out-of-the-pocket price.
  • An HSA to pay for your care. You won’t be taxed for the money that you put in an HSA. 
  • Depending on the deductible, different bronze plans can qualify as HDHPs.

Which Doctors May You Visit?

The doctors that you can visit varies depending on the plan:

  • HMO
  • PPO
  • EPO
  • POS

What Will You Pay?

You will have to pay the following:

  • Premium
  • Deductible 
  • Co-pays/co-insurance

Conclusion

That’s a lot of plans that we talked about.

Confused?

Well, don’t be.

If you have any additional doubts in your mind, you can always reach out to us. We are here extended hours during Health Insurance season. We are available by phone at 813-563-5577. You can also stop by our office at 1430 E Fletcher Ave. Tampa, FL 33612. After hours? Contact us on our website HERE. We look forward to assisting you with your Health Insurance needs.

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Contact Star Nsurance today to get a FREE insurance quote.

Call 813-563-5577. Se habla español.