Health insurance is the best way to protect your family without being left with a huge bill when medical attention is needed. There are over 900 health insurance companies in the United States, with four major types of plans.
Need some guidance on where to start looking? You can find out about the best health insurance plans here.
Health Maintenance Organization
Health Maintenance Organization (HMO) is one of the four primary healthcare plans in the United States. When you choose this plan, you’ll have to use an in-network primary care doctor. This will be the physician who’ll give you yearly check-ups and refer you to a specialist when needed.
If you’re an expatriate living abroad, you may also consider exploring expatriate health insurance options. This plan caters to the unique needs of individuals living abroad, providing comprehensive coverage for medical expenses during their stay in the country.
The specialists will be in your network, so their services will be covered with insurance. You need to have a referral for a specialist for it to be covered. If you go without one, you’ll have to pay out of pocket. When you go out of the network, you’ll receive no coverage.
Preferred Provider Organization
Preferred Provider Organization (PPO) insurance coverage doesn’t require you to have a primary care physician.
It’s possible to go directly to a specialist without seeing your primary care doctor first. You’ll be covered by doctors that are considered in-network. When you go out of the network, you’ll have some coverage but have to pay more out-of-pocket expenses.
Point of Service
Point of Service (POS) health care is similar to the HMO plan. You’ll need to have an in-network primary care physician who’ll be responsible for referring you to a specialist in-network.
If you choose to go out of the network, you will have to pay most of the bill but will receive some coverage. You have the freedom to select specialists in-network or out-of-network and still be partially covered.
Exclusive Provider Organization
With an Exclusive Provider Organization (EPO) plan, you don’t need a primary care doctor. You will only get coverage with in-network providers and specialists but don’t need a referral. Any out-of-network care won’t be covered.
What’s Best for My Family?
What to Consider
An important factor you’ll want to ask yourself is whether any unforeseen health conditions might affect you, your spouse, or your children. Are there older family members that had health conditions that are hereditary that you’ll want to be covered for?
When there’s a situation, where you need to see a specialist, is the freedom of choosing one more important to you than the cost? How much extra expense are you willing to pay for medical attention?
Freedom of Choice
If you’re thinking about the Point of Service or Health Maintenance Organization plans, you have to go to your primary care physician before seeing a specialist. If you don’t mind taking this extra step and having your doctor choose a specialist for you, then these plans are right for your family.
With Health Maintenance Organization plans you’ll have to stay in the network to be covered, while with the Point of Service plan when you have a referral to an out-of-network provider, the costs will be lower.
If you want more options with specialists and to be covered, then a Point of Service plan is better for you.
An Exclusive Provider Organization or Preferred Provider Organization plan is the better choice when you want more freedom with your health insurance coverage. You have the option to choose the specialists you wish without the need to visit your primary care doctor first.
When you think you or a family member might need to see a specialist frequently, then these plans are ideal because you won’t have to spend time with your primary care physician.
Where You Live
An Exclusive Provider Organization plan is better if you live in an urban area because you’ll have a lot of access to specialists in the network. This health plan doesn’t cover out-of-network doctors, so when you go, you’ll have to pay a lot of extra expenses.
A Preferred Provider Organization plan is better if you live in an area where access to specialists is difficult or requires you to travel a lot. You’ll receive more coverage with this plan for out-of-network specialists than others without having to see your primary care doctor.
On a Budget
When you’re on a budget, sticking with a Preferred Provider Organization or Point of Service is a better choice because you’ll get coverage in-network and out-of-network. If money is a concern and you don’t mind always staying in the network, the other two are good options, but some freedom is lost.
The Bottom Line
What works for one family isn’t always ideal for another. When choosing the right plan for yours, remember to ask yourself important questions and figure out which one is best for your specific needs.
Be sure that you understand the difference between the four plans to make the best choice for you and your family.