5 Health Insurance Plans You Must Know About!

5 Health Insurance Plans You Must Know About!

May 23, 2020 92 By akhilesh

Health Insurance Plans

Selecting the right health insurance plan for yourself or your small business is very important. In this blog, we have discussed different 5 types of health insurance plans one can avail in the U.S. While some of these plans may be out of budget for some people, others are really cheap and feasible.

Keep reading to understand and evaluate an option for yourself!

Preferred Provider Organization (PPO)

With a PPO plan, an employee is benefitted to use a network of desired doctors as well as hospitals. Providers under this plan are liable to offer medical services to a member at a discounted or negotiated cost. 

If you are picking up this plan then you should keep in mind that you can’t designate any primary care physician. However, you are free to consult any doctors within the network of your plan.

You will also have an annual deductible and you should meet it before the insurance company starts covering your medical bills. In addition to this, you may also have to meet a copayment or a co-insurance.  

In addition to this, there are some services provided outside the network that normally can be a bit expensive.

A PPO plan is the best option for small businesses if its employees:

  • Require flexibility while selecting physicians or other providers
  • Can accept the burden of attaining a referral to consult a specialist
  • Prefer the balance of great provider choices v/s lower premiums

Health Maintenance Organizations (HMO) Health Insurance Plans

With an HMO plan, an employee will have a lower out-of-pocket cost but unlike other plans, he/she will acquire less flexibility to choose physicians or hospitals. Under this plan, you can select a primary care physician (PCP). And if you want to consult a specialist, then you will have to get a referral from your PCP.

This plan generally offers coverage for a larger variety of preventative services. Talking about the deductible, you may or may not be liable to pay it before your coverage begins; however it normally has a copayment.

Most often, there is no need to fill a claim form to file on an HMO. But a major factor you should keep in mind is that most plans under HMO provide no coverage if you go outside of your network without appropriate approvals from your PCP.

An HMO is the best option for small businesses if they:

  • Want lower premiums
  • Prefer the trade-off of in-network services
  • Prefer good preventive services including immunizations or coverage checkups


Point of Service (POS) Health Insurance Plans

POS plans are basically a combination of HMO and a PPO plan. It includes features of both HMO and PPO.

Both in HMO plans and POS plans you will have to select a Primary Care Physician (PCP) from your plan’s network providers.

Normally, services offered under the PCP do not include any type of deductible. 

If you use covered services rendered or referred by your PCP, then you may have to acquire a high level of coverage. On the other hand, if you use services from a non-network provider, then you will have to meet a deductible as well as a low level of coverage.

A POS plan may be the best option for small businesses if its employees:

  • Require flexibility while selecting physicians
  • Want primary care physicians
  • Prefer the balance of great providers choice v/s low premiums

Exclusive Provider Organization (EPOs) Health Insurance Plans

EPO plans are somewhat the same as an HMO plan as they also offer a network of physicians you can use except in certain cases of emergency. As a member of this plan, you can acquire a Primary Care Physician (PCP) who will further offer referrals to in-network specialists.

You will also be liable for small co-payments as well as a deductible.

An EPO plan may be the best option for small businesses if they:

  • Want a balance of less provider choice for lower rates
  • Have a workforce who finds value with a smaller network of providers
  • Have a workforce who are fine with a high cost for unplanned events

Indemnity Health Insurance Plan

These plans are also known as fee-for-service plans due to the predetermined amounts or prepositions of expenses paid to a member for claimed/covered services. 

Under this plan, you will be liable for deductibles as well as co-insurance costs.

An indemnity plan may be the best option for businesses who:

  • Can afford the burden of administration for referral as well as claims paperwork
  • Can find a balance of high rates for more service control
  • Have employees who require higher levels of flexibility in terms of doctors as well as hospitals

So, we have come to the end of this blog. Now that you understand every plan, we hope you will face no problem choosing the right health insurance plan that best fits your requirements!