September 24, 2020

When it comes to health insurance, there are several different types of health insurance to choose from. Whether you are shopping for health insurance from your State marketplace, or through a health insurance broker, it helps to be familiar with the options that you will encounter. This is your complete guide to health insurance plans and options for 2020. 

Learn everything you need to know about the different types of health insurance coverage types and deductible levels. Find out what the differences are between the plan types offered through national insurers. And, see which combination of coverage options best serves your health needs and budget. 

Types of Health Insurance and Health Plans Available in 2020

Looking through the myriad types of health insurance available on the marketplace or through a broker can leave your head spinning. There are so many options available, so how do you know which one to choose? Here is everything you need to know in 2020 about the types of health insurance plans available to you.

Health insurance coverage is separated into categories that correspond to your level of deductible. A deductible is the amount of money you have to pay before your health insurance picks up the rest of the cost. In general, the less expensive your insurance plans monthly premium, the higher your deductible.

Types of Health Insurance Deductible Levels

Each level of health insurance is identified by a metal: platinum, gold, silver, and bronze. The top deductible coverage level – platinum – generally covers around 90% of your medical costs while you are responsible for a deductible of about 10%. Since platinum-level health insurance covers the vast majority of your medical costs, it carries the highest monthly premium.

The next highest level of coverage is gold, which covers about 80% of medical costs. Since gold-level plans cover fewer medical costs than platinum plans, gold carries a lower monthly premium than platinum, but higher than that of silver. Silver level plans cover 70%, leaving you a 30% deductible, and bronze level covers 60% of medical costs. 

Catastrophic policies also are available to supplement high deductibles. In 2020, catastrophic policies generally payout after you surpass about $8,000 in deductible costs. Also, catastrophic insurance has to cover preventative care and your first 3 visits to a primary care physician for free, regardless of your deductible level.  

Health Insurance Plans by Care Level

Most national big-brand health insurance providers – such as Anthem, Blue Cross Blue Shield, Aetna, United, or Cigna – offer certain types of health insurance plans. This coverage is spelled out in a health plans Summary of Benefits. Each type of plan exists to best fit your specific medical needs and budget. 

Health Maintenance Organization (HMO) Plan

A Health Maintenance Organization (HMO) plan is the most common type of health insurance coverage. With an HMO plan, you have the least freedom to choose a care provider, and the least amount of paperwork to fill out. Your HMO dictates the network of healthcare providers from which you can choose.

The upside of an HMO plan is that there is very little paperwork to fill out since you are not required to file claim forms. On the other hand, your health services are all provided through a predetermined network of providers and facilities. If you end up going to a provider outside of your HMO’s network, you have to pay the bill out-of-pocket. 

HMOs require you to pay a monthly premium, a deductible, and can often include copays. A copay is a flat rate you pay when receiving care and is usually around $15 to $30. You might also be responsible for coinsurance fees, which is calculated based on a percentage of the cost of care.

Preferred Provider Organization (PPO) Plan

A Preferred Provider Organization (PPO) coverage plan offers more freedom to choose your medical care provider, as well as to see a specialist without the need for a referral from an in-network physician. If you decide to see an out-of-network provider, however, you have to pay a higher out of pocket expense, as well as fill out more paperwork. Like an HMO, when using providers in-network for your PPO plan, there is very little or no paperwork involved.

With a PPO plan, you pay the same expenses as are required in an HMO, except for out-of-network care. If you receive care from out-of-network providers that charge more than the areas average, you might be expected to make up the remainder. PPO coverage requires you to pay an out-of-network provider before filing a claim for reimbursement to your PPO coverage provider. 

Exclusive Provider Organization (EPO) Plan

Unlike a PPO plan – Exclusive Provider Organization (EPO) plans do not cover the costs of care for out-of-network providers, except in the case of an emergency. But, the premiums for EPO plans are generally less expensive than that of a PPO plan. EPO plans offer less freedom to choose your provider than that of a PPO plan, but more choice than with an HMO. 

You are free to choose any care provider inside your EPOs network of providers. If you choose a provider outside of your network, there is no coverage from your EPO plan. And, with an EPO, most insurance carries little to no deductible. 

Point-of-Service (POS) Plan

A Point-of-Service (POS) health insurance plan allows for more freedom to choose your care provider. It combines features from an HMO plan and a PPO plan. You have a primary physician who may refer you to specialists within your POS network, and it provides minimal coverage for out-of-network care providers and facilities. 

If you receive care or see a provider outside of your POS network, you must file a claim for partial reimbursement. When receiving care from in-network providers there is little to no extra paperwork involved. Most POS plans charge a premium, copays, and a deductible associated with care outside of preventative services.

With all the options available, how do you know which one is the best choice for you? The right health insurance for you is the one that best suits your health needs and budget. If you want help learning about the types of health insurance available and which one best fits your needs, talk to an insurance professional today.