- Health Insurance Basics
What are the different types of health insurance?
Different types of health insurance plans meet different needs. When you compare options, it's important to understand how they are structured.
Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.
High Deductible Health Plan (HDHP)
High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1250 per year for individual coverage and $2500 for family coverage.
Catastrophic Health Insurance Plan
A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher. This means you must pay thousands of dollars out-of-pocket before full coverage kicks in.
In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received "hardship exemptions". Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs.
How do I learn about a plan's networks and care quality?
When comparing Marketplace plans you'll be able to review the providers in each plan's network. You can also find quality information about doctors, hospitals, and other care providers by using our quality compare tools.
How do I know if my doctor is in a plan's network?
When reviewing plans in the Marketplace, you'll see a link to a list of providers in each plan's network. If staying with your current doctors is important to you, check to see if they're included before choosing a plan.
What are CO-OPs?
The health care law provides funding for “Consumer Operated and Oriented Plans,” known as “CO-OPs.” These non-profit health insurance issuers are member owned and controlled. They must reinvest any profits to lower premiums, improve benefits, or improve the quality of care for their members. They create more competition in the markets where they operate, offering consumers additional choices.
When you shop for coverage in the Marketplace, some of the plans you see may be offered by CO-OPs. You can find out whether they are by visiting the plan’s website.
A CO-OP isn’t a type of insurance plan. It’s a type of insurance company. CO-OPs may decide to offer PPOs, HMOs, or other types of insurance plans.