When you’re shopping for health insurance, you’ll come across a lot of different acronyms. These are designed to tell you about the different aspects of the plans (e.g., how you get care, the cost you pay). Therefore you need to understand these differences so you can find an affordable insurance premium.
PPO (Preferred Provider Organization)
These are flexible plans in that they’ll allow you to receive health care outside of your provider network. You can also see a specialist without getting a referral from your primary care physician. This is great because you’ll have more choices in providers, but that freedom comes at a price. You’ll pay more for out-of-network care. This is why PPOs have a higher insurance premium than other plans.
HMO (Health Maintenance Organization)
With this coverage, you’re limited to seeing providers who are in your network. These providers will either work directly for you or have a contract with your HMO. This means that your primary care physician will need to coordinate most of your care (e.g., you’ll need a referral to see a specialist). If you decide to seek care outside of the network, your HMO won’t pay for it unless it’s an emergency. However, this means that you’ll have lower health insurance premiums than what you’d pay for other types of health insurance.
EPO (Exclusive Provider Organization Plan)
An EPO will only cover you for seeing professionals within their network unless it’s an emergency. This is different from an HMO in that doctors don’t work or contract with the EPO, and when you want to see a specialist, you probably won’t need a referral. Also, unlike an HMO, doctors don’t work for or contract with the EPO. Here you’ll pay less in insurance premiums than with a PPO, but you’ll pay more than with an HMO.
POS (Point-of-Service Health Plan)
These plans have similarities to both a PPO and an HMO. Members pay less when visiting a provider that’s within their network, but they can seek care outside the network as long as you have a referral and you’re willing to pay an extra cost. You’ll also need a referral to see specialists.
HDHP (High-Deductible Health Plan)
Unlike the other types of health insurance that are listed here, an HDHP isn’t a benefit design. It simply means you have a high annual health insurance deductible for any type of benefit design. In 2023 your total annual out-of-pocket costs for in-network services can’t be more than $7,500 for an individual and $15,000 for a family. The nice thing is that your insurance premiums are low, but with a high deductible, your out-of-pocket costs are high if you need to seek regular medical care throughout the year. There is a significant advantage to this plan; you can pair it with a health savings account (HSA) so that you can save money and pay for any medical services you need without being taxed.
The Best Type of Health Insurance
Unfortunately, this isn’t something where “one size fits all.” Since each plan comes with pros and cons, the right plan for you will depend on what you need. This is why it’s important to compare and contrast the various plans and their insurance premiums, so you get a better sense of which is right for you. Additionally, you’ll find that the price you pay will vary depending on the type of plan you choose, your age, and how many people the plan covers. For help finding the best plan for you, contact us at Gemini Insurance Company in Palm Harbor, FL, today.
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