If you’re in the market for an individual health insurance plan, you may be feeling a little lost. You’re looking for insurance to cover your prescriptions and visits to the doctor, but there are simply too many options available. For help wading through the sea of seemingly nonsensical letters that describe different types of coverage, see our handy guide below.
It’s important to realize that this is only a quick overview of the four major types of individual health insurance policies available. For a more detailed description (or advice concerning your insurance) call your Massachusetts insurance agent.
Health Maintenance Organizations (HMOs)
In an HMO, you are limited in your freedom to choose a health care provider. You must choose a Primary Care provider in your HMO’s network. That Primary Care provider will most likely need to issue you a referral before you can see any type of specialist.
Minimal amount of paperwork compared to the other types of health insurance policies. Predictable out-of-pocket costs, and co-pays for each type of care.
Preferred Provider Organizations (PPOs)
With a PPO, you will have more freedom to choose your health care providers when compared to an HMO. This added freedom comes with a cost, though. Typically, a PPO has slightly higher out-of-pocket costs than HMO plans. There is also typically additional paperwork required if you wish to see a doctor out of the PPO’s network.
When you choose a PPO, you will need to pay a monthly premium, as well as copay or coinsurance for your doctor’s visits. In addition, some PPOs will require you to pay a deductible. There will most likely be no paperwork required when you see in-network doctors, but seeing an out-of-network providers may require you to full out a claim for in order to get reimbursed.
Point-of-Service Plans (POS)
HMOs and PPOs are without a doubt the two most well-known types of individual health insurance policies. What some people don’t realize, though, is that there are many other options available that may better fit their needs. For example, a Point-of-Service plan is a combination of an HMO and a PPO – with this plan you will have a primary care provider that will issue you referrals to specialists, but you still have the freedom to see out-of-network providers if you are willing to pay slightly increased costs.
The cost of a POS plan is typically slightly higher than an HMO, but less than a PPO. For some people, it is a good mix of freedom and affordability.
High-Deductible Health Plans (HDHPs)
Typically paired with a Health Savings Account (HSA), a HDHP is simply a health plan (it can be an HMO, PPO, or POS) with a very high deductible. In this case, the insured person pays for most of their health care out of pocket, with a cap if the maximum ‘out-of pocket amount’ is reached.
To talk to an expert about your individual health insurance options, and to find out more about the health insurance options offered here at Vargas and Vargas Insurance Agency, all you need to do is call 617-298-0655. Our friendly and knowledgeable agents would be happy to answer all of your health insurance questions, as well as to get you a free quote on a new health or life insurance policy.
