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What Are the Main Types of Health Insurance?

Couple looking through and comparing their health insurance options.

Most of us probably do research when facing a major purchase before making a final decision. Take buying a car for example; it’s unlikely that you walk into a lot and buy the first car that you see. You’ll want to understand the different makes, models, features, and costs to find a car that fits what you’re looking for.  

Take this same mentality when it comes to choosing your healthcare coverage. You’ll quickly find that there are countless options available to you – but not all will work for what you’re looking for. One of the major factors to consider when choosing health insurance is the type of plan.

There are four main types of health insurance plans:

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Exclusive provider organizations (EPOs)
  • Point-of-service (POS) plans

Each of these plans offer different features – the goal is to find the one that offers the best benefits for your unique situation.  

What Are Health Maintenance Organizations?

Health maintenance organizations (HMOs) are most commonly known as budget friendly plans. These plans typically include low costs for premiums and fixed costs for certain health services, such as doctor visits. 

With HMOs, you will be required to choose a primary care physician in the covered network. All health services will be funneled through your primary care physician – so it’s important to find one that you are comfortable with and trust. Not only will you maintain regular preventive care visits through them, but they will also be responsible for referring you to any specialists, such as a cardiologist or dermatologist.  

HMOs are traditionally a good option for individuals who are on a tight budget and are healthy with no or few health issues. However, to get the lower monthly health insurance premium, you do have to be comfortable with a higher deductible when you need healthcare.  

What Are Preferred Provider Organizations?

Preferred provider organizations (PPOs) offer plans with the most freedom in the healthcare providers you see. These plans have a wide network of participating health services, so you have a variety of doctors, hospitals, healthcare professionals, and facilities to choose from.  

While these plans may hold higher premiums (more than with an HMO or EPO plan), you are not required to choose a primary care physician and are able to see specialists and out-of-network doctors without a referral.

PPOs are traditionally a good option for those with a higher budget for health insurance premiums and are expecting to need higher levels of healthcare services, such as individuals living with a chronic illness, or who wish to have control over what healthcare providers they see.

What Are Exclusive Provider Organizations ?

Exclusive provider organizations (EPOs) have extensive network offerings with a number of participating providers in the network. These plans hold lower monthly premiums, but deductibles may be higher when you need healthcare. 

Whether or not you need a primary care physician depends on your plan – but typically, if you’d like to see a specialist who is a part of your network, you won’t need a referral. EPOs do not cover out-of-network providers (unless, of course, there is an emergency situation). That means that if you see a healthcare provider out of your network, you will likely pay the full cost of services out-of-pocket. 

For those looking to have national coverage options, whether due to work travel or family in another state that you frequently visit, an EPO is typically a good option. EPOs are usually more pocket-friendly than a PPO, but individuals will pay a higher deductible when receiving healthcare services. 

What Is a Point-of-Service Plan?

Point-of-service (POS) plans are affordable health insurance plans that also include out-of-network coverage. Premiums are a bit higher, but these plans offer flexibility when it comes to the choice of healthcare providers.

For a POS plan, you do need to have a primary care physician give you a referral before visiting a specialist. However, out-of-network doctors are covered, though the cost will be a bit higher than in-network healthcare providers. 

Those who frequently travel or have a chronic condition with one or more doctors not in the same network are traditionally a good candidate for POS plans. 

What Type of Health Insurance Is the Best For Me?

Now that you have a better understanding of the four types of health insurance plans, you may be asking yourself, “which of these plans is the best?” There isn’t exactly a clear answer to this question – it all depends on what you’re looking for.

If you’re a generally healthy individual and don’t frequently visit the doctor, you may be interested in a plan that offers higher deductibles and lower premiums (like HMOs).

If you require or are interested in healthcare services beyond preventive care, it may be best to choose a plan with a lower deductibles and coinsurance to have a more predictable cost (like PPOs).

If you’re looking for a wide network and access to specialists, you’ll probably want to find an option that includes an extensive list of available providers and facilities or coverage for out-of-network specialists (such as EPOs or POS plans).

When it comes down to it, though, it’s important to strike the right balance between cost and coverage. While you obviously don’t want to break the bank, you also want to heave available access to the healthcare services and providers you need to maintain a healthy lifestyle.

Before choosing your plan, consider the healthcare services you’re interested in, healthcare providers that you would like included on your plan, and any prescription medications you need included. Make sure to also keep in mind that your healthcare expenses don’t end with the monthly payment to your insurance provider – your costs include your premiums, deductibles, co-pays, and co-insurance. 

Discover What Health Insurance Plan Is Right for You With Find The Plan

We at Find The Plan are dedicated to find the right kind of health insurance coverage for you and your family. We’ll explore the different types of health insurance and offer our personal recommendation on the best plan to suit your needs.

Your conversation with an expert agent goes beyond your date of birth and income – we work with you to build a relationship and get a better understanding of what you need with your healthcare coverage. We’ll discuss budget, any healthcare providers you’d like covered, the medications you take, and what exactly you expect to get out of your insurance plan. By working together, we’ll narrow down your health plan options to clearly find the right type of health insurance plan for you. 

Another benefit? We don’t just sign you up and leave the plan alone – we continuously monitor your healthcare coverage and touch base, when need be, to ensure that the insurance that you choose works the way you need it to. And, since we have access to all plan options, we’ll you know if a new plan becomes available that will either save you money on your current coverage or help you gain new benefits. 

To get started, we recommend completing our PlanMatch tool. You can complete the questions in just five minutes, and your answers will give our team a better idea of what you’re looking for before we even pick up the phone. Once your profile is complete, you can either contact our team right away or schedule an appointment at a time that is convenient for you.