Types of Health Insurance in USA

Types of Health Insurance in USA

Types of Health Insurance in the USA – Health Insurance is a major subsector in Insurance that deals with the care of the insurance policyholder. The goal is to maintain the health, and therefore the life of the policyholder through many different plans which work for the singular purpose of paying for or otherwise providing medical care for the insured.

In this article, we look at the various types of Health Insurance in the United State Of America currently available to you. This article reflects recent changes in government policy, and incorporates the Medical Insurance regime that came into place with the Affordable Care Act {ObamaCare} of 2010. The number of Americans without health insurance has been reduced by half since 2013. Many of the reforms enforced by the Affordable Care Act of 2010 were intended to extend health insurance coverage to those without it.
Some of the Health Insurance Types that Exist in the United States are as follows:

Types of Health Insurance in USA

  • 1. Federal Employees Health Benefits Program
  • 2. Indian Health Service
  • 3. Medicaid / State Health Insurance Assistance Program (SHIP)
  • 4. Medicare
  • 5. Prescription Assistance (SPAP)
  • 6. Military Health System / TRICARE
  • 7. State Children’s Health Insurance Program (CHIP)
  • 8. Program of All-Inclusive Care for the Elderly (PACE)
  • 9. Veterans Health Administration

Private health coverage Types: These are the different types of Insurance policies that are offered by Private Insurance companies. The term ‘Private Insurance companies’ here means insurance companies that are not owned by the government. They may be Limited Liability Companies (LLC) or Publicly Listed Companies (PLCs). This article will focus on the insurance policies and types that are offered by the Private Insurance Companies. Some of them are listed below.

  • 1. Health Maintenance Organization (HMO)
  • 2. Preferred Provider Organization (PPO)
  • 3. Exclusive Provider Organization (EPO)
  • 4. Point-of-Service Plan (POS)
  • 5. Catastrophic Plan
  • 6. High-Deductible Health Plan With or Without a Health Savings Account

You have many different choices when you look for health insurance. If you’re buying from a sponsored issuer or from an insurance broker, you’ll probably choose from health plans differentiated by the level of benefits that they offer. They are usually: bronze, silver, gold, and platinum.

Bronze plans usually have the least coverage, and platinum plans usually have the most. If you are under 30 years old, you may also be able to buy a high-deductible, catastrophic plan.

How are insurance policies different? Each one pays a preset share of costs for the average policyholder. The details can vary across policies or insurance companies. In addition, deductibles- which is the amount you pay before your policy covers 100% of your health care expenses — differ according to plan and also the insurance company.

  • Platinum Plan: covers 90% on average of your medical costs; you only pay 10%
  • Gold Plan: covers 80% on average of your medical costs; you only pay 20%
  • Silver Plan: covers 70% on average of your medical costs; you only pay 30%
  • Bronze Plan: covers 60% on average of your medical costs; you only pay 40%
  • Catastrophic Policies: Catastrophic policies pay only after you have reached a very high deductible ($7.350 as at 2018). Catastrophic plans must also pay for the first three primary care visits and also your preventive care hospital visits for free, even if you have not yet reached your deductible premium.

You will also see that some insurance brands are associated with the care levels. They may have been pioneers in these kinds of policies thus causing a close association with the insurance policies. We will not mention those here in order to maintain neutrality.
Each insurance company may offer one or more of these four very common types of plans:

  • 1. Health maintenance organizations (popularly called HMOs)
  • 2. Preferred provider organizations (popularly called PPOs)
  • 3. Exclusive provider organizations (popularly called EPOs)
  • 4. Point-of-service (popularly called POS) plans
  • 5. High-deductible health plans (popularly called HDHPs), which may be linked to health savings accounts (HSAs)
Types of Health Insurance in USA
Types of Health Insurance in USA

Take a minute to learn how these plans are different. Being familiar with the types of policies can help you pick the one that best fits your budget and meets your peculiar health care needs. To learn the specifics about a company’s particular health policy or product, it is always best to consult a customer care agent. However, we have briefly written a summary of benefits.

1. Health Maintenance Organization (HMO)

An HMO is a kind of Insurance Company that offers health insurance policies. They deliver all health services through affiliation with a network of healthcare providers, hospitals, clinics, and such and such facilities. With an HMO, you may have the following:

  • Very little opportunity to choose your health care providers
  • The least amount of paperwork and forms to fill when compared to other plans
  • You may be assigned a primary care doctor to manage your health and also to refer you to specialists when the need arises. The care is covered by your insurance policy.
  • HMOs will usually require a referral before you can see a specialist.

Your HMO (Health insurance provider) usually dictates What doctors you can see. If you see a doctor who is not in the HMO’s network, you may have to pay the full bill by yourself. Emergency services obtained at an out-of-network hospital must be covered at the same rates with your HMO’s doctors, but non-participating doctors who treat you in such circumstances in the hospital can bill you.

What you pay: Fees and Rates-

Premium: This is the basic fee you pay each month for insurance.
Deductible: Your policy may require you to pay (or save) the amount of a deductible before it covers Health care except for preventive care.
Copays and/or co-insurance cover for each type of care. A copay is a flat fee charged, such as $15, that you pay when you get health insurance. Coinsurance is when you pay part of the charges for Health care, for example, 20% of total health care costs. These charges usually vary according to your insurance policy and the insurance company.

2. Preferred Provider Organization (PPO)

A Preferred Provider Organization (PPO) is a health insurance provider very similar to an HMO in that it works by affiliating itself with a network of doctors, hospitals, and such medical facilities. The major difference between an HMO and a PPO is that when you sign up with a PPO you get to choose the doctors that you want, provided that you have the money to pay for such cover. When you sign up with a PPO you get the following:

  • A moderate amount of power to choose your health care providers –a lot more than an HMO; you do not need to get a referral from a primary care doctor before you can see a specialist.
  • Higher costs from your pocket if you see out-of-network doctors as against when you see in-network providers
  • More forms to fill than with other plans if you see out-of-network providers. These forms are usually about money.
  • You can usually see any doctors in the PPO’s network; you can also see out-of-network doctors, but the only thing is that you’ll pay more.

What you pay- Costs Implications:

  • Premium: This is the basic cost you pay each month for insurance cover.
  • Deductible: Some PPOs may have a deductible fee. If so you may likely have to pay a higher deductible if you go out to see an out-of-network doctor.
  • Copay or coinsurance: A copay is a flat rate, such as $15, that you pay when you get Medical care. Coinsurance is when you pay a percentage of the charges for care, and then your insurer pays the balance. for example, you may pay 20%.
  • Other costs: If the out-of-network doctor you visit charges more than others in the area do, you may have to pay the balance of the fee after your insurance pays its share.
  • Paperwork involved. There’s little to no paperwork involved with a PPO if you see their affiliated doctor. If you use an out-of-network doctor or hospital, you’ll have to pay the facility. Then you have to file a claim to get the insurer to pay you back.

3. Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO) is a kind of health insurance provider that offers very limited insurance cover, using a very limited number of doctors and health facilities.
With an EPO, you usually have:

  • Freedom to choose your health care providers(doctors and hospitals) — more than an HMO; you do not have to get a referral from a primary care doctor in order to see a specialist.
  • No coverage for doctors outside insurers network; if you see a hospital that is not in your plan’s network – except during an emergency – you will have to pay the full cost yourself.
  • Lower premium than a PPO, even when offered by the same insurer
    You can see Any doctors in the EPO’s network; however, there is no coverage for out-of-network providers.

What you pay with this plan:

  • Premium: This is the fee you pay each month for insurance cover.
  • Deductible: Some EPOs may have a deductible amount that you pay before your plan kicks off.
  • Copay or coinsurance: A copay is a flat fee that is charged, such as $15, that you pay when you get medical care. Coinsurance is when you pay a certain percent of the charges for medical care, for example, you may need to pay 20%.
  • Other costs: If you see an out-of-network provider you will have to pay the full bill by yourself.
  • Paperwork involved. There’s usually little to no paperwork with an EPO Once you sign up and pay your premiums on the time you are good to go.

4. Point-of-Service Plan (POS)

A POS plan is a special insurance policy that blends features of an HMO with a PPO. With the POS plan, you may likely have:

  • A lot more freedom to choose your doctors than you would in an HMO
  • A moderate amount of forms and papers if you see out-of-network providers
  • A primary care doctor who treats you for a long time. He coordinates your care and also refers you to specialists
  • You can see any in-network providers that your primary care doctor refers you to.
  • You can also see out-of-network doctors, however, you’ll pay more.

What you pay- Costs Involved:

  • Premium: As usual, This is the cost you pay each month for insurance.
  • Deductible: Your plan may require you to pay the amount of deductible fee overtime before it covers any care that goes beyond preventive services.
  • Copays or coinsurance: You will likely pay either a copay, such as $15, which is a percent of the charges for your policy. Copayments and coinsurance are usually higher when you use an out-of-network doctor.
  • Paperwork involved. If you go out-of-network for care, you will have to pay your medical bill. Then you submit a claim to your POS insurer to pay you back.

5. Catastrophic Plan

If you are less than the age of 30 you can purchase a catastrophic health plan. With a catastrophic health plan you may likely have:

  • Lower premium fees. They usually do not charge much premiums.
  • They usually offer 3 primary care visits before the deductible applies
  • They usually offer Free preventive care, they give this even if you haven’t met the deductible
  • You can usually see Any doctors in the insurer’s network; individual policies may also have additional rules on the specialists.

What you pay- Cost Implications

  • Premium: As usual, This is the cost you pay for each month for insurance cover.
  • Deductible: A catastrophic health plan usually has a deductible of about $7,350 for an individual and about $14,700 for a family (as at 2018.) After you reach that deductible fee, the plan will then pay 100% of your medical costs for covered benefits in your policy.
  • Paperwork involved. You will absolutely want to keep track of your premiums and expenses to show you have met the deductible.

Related:

Tag: Types of Health Insurance in USA Article filed by @ikepius

Leave a Reply

Your email address will not be published. Required fields are marked *