Understanding Different Health Insurance Plans
Insurance jargon can be confusing when you are selecting a new health insurance plan. Each plan type can offer medical coverage differently. It is important to do your research before you enroll in a plan that does not work for your health needs.
The Affordable Care Act (ACA) requires traditional health plans to cover the 10 essential services. However, it’s important to remember that your access and financial requirement for these essential services may vary by plan type.
If you have a budget and do not need medical care often, having a cheap health insurance plan may be a priority for you. A Health Maintenance Organization (HMO) plan typically has the least expensive monthly premium. Since the plans limit you to in-network providers only, they can offer cheaper monthly costs.
However, the deductible for HMOs is often higher than other traditional plans. You will need to pay out-of-pocket the sum of your deductible for your insurance plan to cover services. Some preventive services have fixed copayments or a certain percentage of coinsurance.
This means that you will pay a certain amount for a service, such as a wellness visit, and your plan will cover the rest. The amount you pay goes towards your deductible.
You will need to select a primary care provider (PCP) to be your health care gatekeeper. Your PCP will manage your medical care. To see a specialist, your PCP will need to refer you to an in-network one, or your HMO will not cover the costs.
For the most part, you will exclusively rely on health care providers that are in your plan’s network. However, your HMO plan will cover out-of-network medical emergencies.
You can search for which in-network providers are available in your area and with your plan.
Your current doctor may not be in your HMO’s network, and you will need to switch. You might want a health insurance plan that gives you more freedom if you prefer your current medical team.