Types of health insurance:
Health Maintenance Organization (HMO) Plans
- Features: Requires members to choose a primary care physician (PCP), referrals needed to see specialists, and coverage limited to care from doctors who work for or contract with the HMO.
- Pros: Lower premiums, lower out-of-pocket costs, focus on preventive care.
- Cons: Less flexibility in choosing healthcare providers requires referrals for specialists.
Preferred Provider Organization (PPO) Plans
- Features: Provides more flexibility in choosing healthcare providers, allows seeing specialists without referrals, and covers out-of-network care at a higher cost.
- Pros: Greater choice of doctors and hospitals; no need for referrals to see specialists.
- Cons: Higher premiums, higher out-of-pocket costs for out-of-network care.
Exclusive Provider Organization (EPO) Plans
- Features: Similar to PPOs but without out-of-network coverage, except in emergencies, there is no need for referrals to see specialists.
- Pros: Lower premiums than PPOs; flexibility in choosing specialists without referrals.
- Cons: No coverage for out-of-network care (except emergencies); limited provider network.
Point of Service (POS) Plans
- Features: Combines features of HMOs and PPOs, requires a PCP and referrals for specialists, and covers out-of-network care at a higher cost.
- Pros: Greater flexibility than HMOs; coverage for out-of-network care.
- Cons: Higher out-of-pocket costs for out-of-network care requires referrals for specialists.
High-Deductible Health Plans (HDHP)
- Features: High deductible before insurance starts to pay, often paired with Health Savings Accounts (HSAs) to help pay for medical expenses.
- Pros: Lower premiums, potential tax benefits with HSAs, good for those with few medical expenses.
- Cons: Higher out-of-pocket costs until deductible is met, not ideal for those with high medical expenses.
Catastrophic Health Insurance Plans
- Features: Designed for young, healthy individuals, covers essential health benefits after a high deductible is met, lowering premiums.
- Pros: Low premiums; protection against very high medical costs.
- Cons: Very high deductible, limited coverage for routine care.
Medicare
- Features: Federal program for individuals 65 and older and some younger people with disabilities.
- Parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
- Pros: Comprehensive coverage for eligible individuals; guaranteed acceptance.
- Cons: Out-of-pocket costs and coverage gaps can be complex to navigate.
Medicaid
- Features: State and federal program providing health coverage to low-income individuals and families.
- Pros: Low or no cost, comprehensive coverage for eligible individuals.
- Cons: Limited to those who meet eligibility criteria; varying coverage and benefits by state.
Short-Term Health Insurance
- Features: Temporary coverage for short periods (e.g., between jobs), lower premiums, limited coverage.
- Pros: Affordable, quick enrollment, temporary protection.
- Cons: Does not cover pre-existing conditions, has limited benefits, and is not a long-term solution.