Monday, May 20

Types Of Health Insurance In USA

Health Insurance
Health Insurance

In the Market of Health insurance, you will get a lot of options to choose from. If you’re buying from your state’s Marketplace or from an insurance broker, you’ll choose from health plans organized by the level of benefits they provide. Offers look like Bronze, Silver, Gold, and Platinum. All of them differ in their coverage accordingly. Bronze has the least coverage whereas Platinum has the highest coverage.

How are the plans different?

Each plan pays a set of costs for the average enrolled person. generally with the least expensive carrying the highest deductible.

  1. Platinum: covers 90% on average of your medical costs; you pay 10%
  2. Gold: covers 80% on average of your medical costs; you pay 20%
  3. Silver: covers 70% on average of your medical costs; you pay 30%
  4. Bronze: covers 60% on average of your medical costs; you pay 40%
  5. Catastrophic: Catastrophic policies pay after you have reached a very high deductible ($8,150 in 2020).  Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.

Types of Health Insurance Plans

The major insurance brands in USA like Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United provides one or more plans among these.

Doctor
Doctor

Health Maintenance Organization (HMO)

Health management organizations works with a network of healthcare providers and facilities to deliver all the health services. With this plan of insurance you may have these sorts of limitations.

  • You will get the least freedom to choose your health care providers
  • They prodive the least amount of paperwork compared to other plans
  • A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan. most of the HMOs will require a referral before you can see a specialist.

Doctors you can Look For. Any in your HMO’s network. On the off chance that you see a specialist who isn’t in the network. you’ll need to cover the full bill yourself. Crisis administrations at an out-of-network medical clinic should be shrouded at in-network rates, yet non-partaking specialists who treat you in the medical clinic can charge you.

What you have to pay:

  1. Premium: This is the cost you pay each month for insurance.
  2. Deductible: Your plan may require you to pay the amount before it covers care except for preventive care.
  3. Copays and/or co-insurance for each type of care. A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%. These charges vary according to your plan and they are counted toward your deductible.

Paperwork involved. There are no claim forms to fill out.

Preferred Provider Organization (PPO)

Preferred Provider Organization may have these sorts of limitations.

  1. A moderate amount of freedom to choose your health care providers more than an HMO, you do not have to get a referral from a primary care doctor to see a specialist.

Doctors you can Look For. You can visit any of the doctors in the PPO network. If you go to the doctor out of list then you may have to pay more.

What you have to pay:

  1. Premium: You have to pay each month for insurance.
  2. Deductible: Some PPOs may have a deductible. if you see an out-of-network doctor you may have to pay a higher deductible
  3. Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%.
  4. Other costs: If your out-of-network doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.

Paperwork involved. There is no paperwork when you visit the in network doctor, but if you visit out of network doctor then you have to file your claim for the higher amount you have paid.

Exclusive Provider Organization (EPO)

In EPO, You may have

  1. A moderate amount of freedom to choose your health care providers — more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
  2. No coverage for out-of-network providers; if you see a provider that is not in your plan’s network – other than in an emergency – you will have to pay the full cost yourself.
  3. Lower premium than a PPO offered by the same insurer

Doctors you can Look For. You can visit any of the doctor in the EPO network, There is no coverage for out network Doctors.

What you have to pay:

  1. Premium: This is the cost you pay each month for insurance.
  2. Deductible: Some EPOs may have a deductible.
  3. Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%.
  4. Other costs: If you see an out-of-network provider you will have to pay the full bill.

Paperwork involved. There is no paperwork involved.

Point-of-Service Plan (POS)

A POS plan you may have:

  1. More opportunity to pick your medical care suppliers than you would in a HMO
  2. A moderate measure of desk work on the off chance that you see out-of-network suppliers
  3. An essential consideration specialist who organizes your consideration and who alludes you to subject matter experts

Doctors you can Look For . You can see in-network providers your primary care doctor refers you to. You can see out-of-network doctors, but you’ll pay more.

What you have to pay:

  1. Premium: This is the cost you pay each month for insurance.
  2. Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services.You may pay a higher deductible if you see an out-of-network provider.
  3. Copays or coinsurance: You will pay either a copay, such as $15, when you get care or coinsurance, which is a percent of the charges for care. Copayments and coinsurance are higher when you use an out-of-network doctor.

Paperwork involved. If you go out-of-network, you have to pay your medical bill. Then you submit a claim to your POS plan to pay you back.

Catastrophic Plan

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

  1. Lower premium
  2. 3 primary care visits before the deductible applies
  3. Free preventive care, even if you haven’t met the deductible

Doctors you can Look For. Any in the plan’s network; individual plans may have additional rules on specialists.

What you pay:

  • Premium: This is the cost you pay each month for insurance.
  • Deductible: A catastrophic health plan has a deductible of $8,150 for an individual and $16,300 for a family in 2020. After you reach that deductible, the plan will pay 100% of your medical costs for covered benefits.

Paperwork involved. You will want to keep track of your medical expenses to show you have met the deductible

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