Whether you have health insurance through the marketplace or through your employer, your health insurance plan works by partnering with a network of providers.
Whether you're seeking health insurance through the marketplace or getting it through your employer, your private health insurance plan works by partnering with a network of health-care providers. The costs of insurance and physicians that you can see as part of your plan will depend on which type of health insurance plan you have. Below, we’ll break down the different types of health insurance available to you.
HMO plans tend to offer less expensive premiums over other types of private health insurance plans. However, when it comes to accessing a network of health-care providers, HMO plans are the most restrictive. With an HMO, you choose a primary care physician who is in your network. Then, you will need a referral from your primary care physician if you need to see a specialist. These types of plans don’t cover any costs for out-of-network health-care providers.
PPO plans often have more expensive premiums when compared to other types of private health insurance. However, these plans are less restrictive than other types when it comes to the network of providers you can receive care from. With a PPO, you can see in-network physicians at a lower cost, but you still have access to out-of-network health-care providers at a higher cost. Though you will still have a primary care physician, PPOs do not require you to get a referral from your primary care doctor if you need to see a specialist.
EPO health-care plans typically have more expensive premiums than HMOs and lower premiums than PPO plans. EPOs are a hybrid of both HMO and PPO. With an EPO plan, you have the option to see a specialist without a referral from your primary care physician. However, these types of plans do not cover out-of-network physicians, which means you will need to see an in-network provider.
POS plans are also a hybrid of PPO and HMO health-care plans. POS plans often have more expensive premiums than HMO plans and less expensive premiums than PPOs. With a POS plan, individuals have a primary care provider that will coordinate their care using a network that’s similar to HMO. However, they will also be able to access out-of-network providers at a higher cost just like PPOs. The HMO network is more affordable, but it requires a referral to see specialists.
With a high-deductible health plan, you pay less in premiums but experience higher out-of-pocket costs. HDHPs can be HMOs, PPOs, EPOs, or POSs, and the doctors that you can see will vary depending on the type of plan you have. Some high deductible health plans are HSA-compatible, which means that you can use a health savings account to help pay for your care. The money that you put into your HSA isn’t taxed and can be used tax-free on eligible medical expenses.