Whether you’re about to retire from your job and your employer-sponsored health insurance, or you simply want to educate yourself about the available options, it helps to have a general understanding of the current health insurance landscape. These are some of the categories of health insurance explained in terms of the services they cover and cost to the consumer.
You first want to think about your medical needs. Which doctors do you visit and how often? What other services will you need? These will all affect what you will end up paying, so consider everything before deciding on the most prudent course of action.
Currently, there are four general categories of health insurance. All of these plans include free preventive health services. They are bronze, silver, gold, and platinum, and they differ in the deductible and the monthly premium you pay. In general, the less valuable the metal, the lower the monthly premium and the higher the deductible.
The bronze plan was designed for those who don’t typically use a lot of healthcare services. These individuals will pay more when they do go to the doctor, but their monthly premiums are lower. The platinum plan was designed for people who access healthcare services more frequently. They pay higher monthly premiums but shell out much less to see the doctor. Visit the Health Insurance Marketplace to figure out which option is best for you.
There’s another division of health insurance to consider that includes plans such as HMO, EPO, PPO, and POS. These differ in their treatment of networks of providers and whether they require referrals to see specialists for certain procedures.
A health maintenance organization plan (HMO) is a lower-cost option that requires individuals to see clinicians who are in a pre-approved network of providers, except in the case of emergencies. Referrals are needed for procedures and specialists. Similar to an HMO but without the need for referrals are exclusive provider organizations (EPO). If you foresee visiting specialists, an EPO may be a cost-effective solution for you. A preferred provider organization (PPO) doesn’t require you to see providers in their network, although it will cost less if you do. Referrals to see specialists are not required. Finally, a point of service plan (POS) allows you to see providers outside of your network at a slightly higher cost and requires referrals for procedures and specialists. POS plans are intended for those who want options when it comes to their medical care providers with full-service care from a primary physician.
To decide the best health insurance option for you, consider your income, what you’re able to afford, and your medical needs. While it’s impossible to foresee every medical emergency that may come your way within the next year or so, it can pay off to do some careful planning about how you will be using your health insurance, so do your homework about which plans cover the services you anticipate needing.
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