Health Insurance Plans & Network Types

With all the different types of health insurance plans in the marketplace, choosing the right one can sometimes feel like a daunting task. However, knowing just a few things before you begin comparing plans can make it simpler.

There Are 4 “Metal” Categories

These categories: Bronze, Silver, Gold, and Platinum, are based on how you and your plan split the costs. 

Along with Monthly Premiums, There Are Deductible and Out-Of-Pocket Costs

You pay a bill to the insurance company (premium) even if you don’t use medical services during that month. You pay out-of-pocket costs, including a deductible, when you do. It’s important to think about both of these when shopping for a plan.

Plan and Network Types

Some plan types allow you to get care from almost any doctor, hospital, pharmacy, or medical service provider. Some limit your choices or charge you more if you use medical facilities and providers outside their network. You may find all or any of these at each metal level.

Exclusive Provider Organization (EPO)

With the exception of an emergency, services are covered only if you use doctors, specialists, or hospitals within the plan’s network.

Health Maintenance Organization (HMO)

HMOs often provide integrated care, with a focus on prevention and wellness. Coverage is limited to care from doctors who work for or have a contract with the HMO. You may be required to live or work in its service area to be eligible. Out-of-network care (except in an emergency) is not covered

Point of Service (POS)

You pay less if you get services from doctors, hospitals, and other health care providers on the plan’s network. Consulting a specialist requires a referral from the primary care doctor.

Preferred Provider Organization (PPO)

You pay less if you use providers in the plan’s network. Services from doctors, hospitals, and medical facilities outside the network do not require a referral, and you do not have to pay an additional cost.