Families in the US looking for the best health insurance plans can now have a sigh of relief because we’ve got the solution here.
There are several health insurance plans with good health insurance policies in the US.
A health insurance plan is a financial agreement in which you pay a regular fee to an insurance company.
The fee you pay is in exchange for medical expenses. This helps to manage the costs of healthcare services and treatments.
Here is the list:
1. Health maintenance organizations (HMOs)
Are you looking for an affordable health insurance plan for you and your family? Consider HMO.
A health maintenance organization (HMO) can be a public or private company.
HMO provides comprehensive medical care to voluntary subscribers on a prepaid contract.
HMOs bring together a broad range of health services. They deliver those services to you for a fixed, pre-negotiated fee.
There are two main types of HMOs:
- The prepaid group practice model and
- The Medical Care Foundation (MCF) is also called an individual practice association.
The Ross-Loos Medical Group in California, U.S., began the prepaid group practice model in 1929.
In this model, physicians go into a group practice, and there is one insurance agency.
Innovators of this type of HMO include:
- The Kaiser Foundation Health Plan in California,
- the Health Insurance Plan of Greater New York, and
- The Group Health Cooperative of Puget Sound
The MCF usually involves several health insurance companies.
The organization contains individual physicians who receive payment for each service.
The medical-care foundation reimburses physicians through subscribers’ prepaid fees.
Examples of this type of HMO include:
- the San Joaquin Foundation in California and
- the Physician Association of Clackamas County in Oregon.
The only drawback is that you have to wait for referrals before getting a specialist visit,
Still, HMO is one of the best health insurance plans available.
Also Read:
2. Preferred provider organizations (PPOs)
A preferred provider organization (PPO) offers health insurance plans to individuals and families.
It has a network of contract healthcare providers. This includes doctors, hospitals, and other medical professionals.
It is one of the cheapest health insurance plans in the US.
Healthcare facilities and practitioners, also called preferred providers, offer services at low prices. You don’t need to worry about high insurance fees.
You will receive the highest PPO benefit when you visit in-network healthcare professionals. They also offer coverage when they see out-of-network providers.
A preferred provider organization is a managed-care network of medical professionals. It also includes facilities such as primary and specialty physicians and hospitals.
They contract with insurance providers to render services to subscribed participants. These are plan participants or consumers who cover the insurer’s healthcare plan.
They plan, negotiate fees, and schedule services with healthcare professionals and facilities. As such, the agreed-upon rate is always lower than their usual charges.
In exchange for reduced rates, you will pay the PPO a fee to access the network of providers.
PPO participants are free to use the services of any provider within their network.
They encourage but do not decide a primary care physician for your medicals.
You don’t need referrals to visit a specialist.
Subscribers may go out of network for coverage, but it often comes at a higher cost.
3. Exclusive provider organizations (EPOs)
An exclusive provider organization (EPO) combines two aspects of health insurance plans;
- Health Maintenance Organization (HMO)
- and a preferred provider organization (PPO).
EPO plans help you receive healthcare services from pre-approved healthcare providers and facilities. An example is the HMO.
Yet, you have the flexibility to see specialists without a referral.
EPO plans rarely cover out-of-network care except in emergencies. It doesn’t need a primary care physician (PCP).
According to McKinsey & Company, 36% of all plans insurance companies offered on the federal and state exchanges in 2022 were EPOs up from 9% in 2014.
An EPO plan offers a balance between affordability and flexibility in healthcare coverage.
If you choose an EPO plan, you can access a contracted network of healthcare providers. As well as receive comprehensive coverage.
This allows you to access a range of medical services and see specialists without referrals.
4. Point-of-service (POS) plans
A point-of-service (POS) plan is a managed-care health insurance plan with benefits.
This depends on whether the policyholder uses in-network or out-of-network healthcare providers.
A POS plan combines features of the two most common health insurance plans. This includes the health maintenance organization (HMO) and the preferred provider organization (PPO).
POS plans represent a small share of the health insurance market.
Most policyholders have either HMO or PPO plans.
A POS plan is like an HMO.
Here, you choose an in-network primary care doctor. You can also get referrals from that doctor if you want the policy to cover a specialist’s services.
A POS plan is like a PPO because it covers out-of-network services. But you will have to pay more than you used in-network services.
Yet, the POS plan will pay more toward an out-of-network service.
The primary care physician makes a referral if you go outside the network without a referral.
The premiums for a POS plan fall between the lower premiums offered by an HMO and the higher premiums for a PPO.
With POS plans, you need to make co-payments. In-network co-payments are often $10 to $25 per appointment.
POS plans also do not have deductibles for in-network services. This is a significant advantage over PPOs.
POS plans offer nationwide coverage, which benefits you if you travel often.
A disadvantage is that out-of-network deductibles are often high.
When a deductible is high, you will pay higher out-of-network services.
If you rarely use a POS plan’s out-of-network services, you would be better off with an HMO, with lower premiums.
Also Read:
5. High-deductible health plans (HDHPs)
A high-deductible health plan (HDHP) is one with high medical expenses.
An HDHP usually has a higher annual deductible (often four figures) than a typical health plan. But it charges lower monthly fees.
The lowest deductible varies from year to year.
The IRS defines an HDHP as a plan with a deductible of at least $1,600 for individuals and $3,200 for families in 2024.
It could also be $1,650 and $3,300 in 2025.
A deductible is the out-of-pocket cost for covered health care before your plan pays.
When you pay part of a claim, the insurance company covers the remaining part. This agreement is in the contract.
HDHPs help to lower healthcare costs. This is by making you more conscious of medical expenses.
The higher deductible also means lower insurance premiums, making monthly costs affordable.
This arrangement benefits healthy people who need coverage for serious health emergencies.
Wealthy families who can afford the deductible also benefit from this medical insurance policy.
This is because it offers access to a tax-advantaged Health Savings Account.
First-dollar coverage plans are the opposite of HDHPs. With these plans, you won’t pay out-of-pocket costs for your covered health care. But you’ll pay a much higher premium.
