Health insurance can be categorized into two main types, private and public. Understanding the options available is the first step to finding an affordable healthcare plan.
Public Health Insurance
There are two main types of health insurance, one of which is public health insurance, provided through a government program, such as Medicare, Medicaid, or CHIP. Public health insurance programs are run and funded by the government but aren’t necessarily free, though the cost at the point of service will be reduced. Federal health insurance programs manage quality and costs of care to help provide reduced costs to the insured. People with this kind of insurance are still responsible for the costs of care, like premiums, deductibles, and other out-of-pocket expenses, though they may not be as high as with other types of insurance.
Private Health Insurance
Any type of health coverage that isn’t received through a government program is considered private health insurance.
Many get their health insurance through a group plan from their workplace. This is employer-sponsored health insurance.
Regardless of where you get your private health insurance, the plan must provide you with ten essential health benefits, such as preventive care and ambulatory services, as mentioned in the Affordable Care Act.
After you’ve determined the main type of health insurance you’re interested in based on its source, you can further categorize your coverage by the type of plan.
Most health insurance policies come under managed care plans, which simply means that the insurance companies work with different medical providers to establish and negotiate costs and the quality of care.
The difference between the main types of plans, that is HMO, PPO, EPO, and POS plans is largely based on the size of the preferred provider network, whether out-of-network providers are covered, and whether you will need a referral to see any specialists.
A Brief Overview
An HMO, or a health maintenance organization, uses a primary care provider as the touchpoint for your care. You’ll need to see them before you get to see a specialist.
PPO, or a preferred provider organization, does not require you to name a primary care physician or even get a referral and may cover out-of-network care at a much higher cost.
EPO, or exclusive provider plans, cover only doctors within your network, but you won’t need to get a referral to see them.
POS, also known as point-of-service plans, require you to choose a primary care physician and then seek one out for referrals. You may also need to get a pre-authorization from the insurer before you choose to get certain medical procedures with POS plans.