If you are a dependent who is not covered by someone else’s health insurance, such as a spouse/partner or parent, it is best to purchase health insurance. Health care costs without insurance can be high.
What types of health insurance are there?
Different types of health insurance include:
- Health Maintenance Organization (HMO)
- Exclusive Provider Organization (EPO)
- Point of Service (POS) Program
- Preferred Provider Organization (PPO)
Not sure which health insurance is best for you? Below are general descriptions of each health plan.
What is a Health Maintenance Organization (HMO)?
HMOs provide you with a choice of local networks of participating doctors, hospitals and other healthcare professionals and facilities. These types of health insurance plans also require you to choose a primary care provider (PCP) from your network. Your PCP is the home for your medical supplies. They will get to know you and help coordinate your overall care. They also need to send you a referral to a specialist on the web. The costs (copays and coinsurance) of HMO plans are generally lower than other types of health plans as long as you stay in network.
What is an Exclusive Provider Organization (EPO)?
The EPO provides you with a network of participating providers to choose from. Most EPO plans do not include coverage for off-grid care, except in emergencies. This means that if you visit a provider or facility outside the plan’s local network, you may have to pay for the entire service yourself.
Depending on the plan, you may or may not need to choose a primary care provider (PCP). You don’t need a GP referral if you want to see a specialist in your network.
What is a Point of Service (POS) program?
POS plans combine features of HMO and PPO plans. Provider networks are usually smaller than PPO plans, and the costs of maintaining the network are usually lower, like HMOs. The POS plan also requires you to choose a primary care provider (PCP) from the plan’s network of doctors and other primary care professionals. Your PCP is your home for care and advice. They get to know you and your health care needs and can help coordinate all of your care.
If you need to see a specialist, you will need a referral. However, like a PPO, you can also choose an in-network or out-of-network expert. If you go to a doctor who is not in the insurance network, your share of the cost will be higher, and you will have to file a claim yourself.
What is a Preferred Provider Organization (PPO)?
PPOs typically provide you with a large network of participating providers, giving you a variety of doctors, hospitals, and other healthcare professionals and facilities to choose from. You can also choose to watch providers outside of the plan’s network, but you’ll be required to pay out of pocket.
Choosing a Primary Care Provider (PCP) Doesn’t Matter
Which health insurance is best for me?
Start by understanding your specific health needs:
- If you’re in good health and don’t see your doctor very often, health plans with higher deductibles usually have lower premiums and can help you save money.
- If you need or expect more than preventive care, consider plans with lower deductibles and coinsurance to make costs more predictable.
