What are the Most Common Insurance Plan Types?

Most Common Insurance Plan Types


It’s not one size fits all for health insurance. There are many different options that can be purchased. Sometimes, like if you are buying from the state or an insurance broker, the health plans are organized in bronze, silver, gold, and platinum tiers. Each tier is based on the amount of coverage they offer. Bronze has the least coverage and platinum has the most. For example, a platinum plan covers 90% of the medical costs you incur and you would only pay 10%. Within these levels, exist different brands. The largest national brands include Aetna, Humana, Blue Cross Blue Shield, and United. Each brand will offer some, if not all, of these types-- Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), Point-of-service plans (POS), High Deductible Health Plans (HDHPS), and Preferred Provider Organizations (PPOs). Being familiar with the different types of health plans will help you choose which best suits you. 


Health Maintenance Organization (HMO): Usually, these plans give you the least amount of flexibility in choosing your healthcare providers, but offer the least amount of paperwork. These types of plans usually require a primary care provider (who is covered by your plan) to refer you to a specialist before it will be covered by your insurance. You can see any doctor, but if it is not in your network, you could be responsible for paying the full amount. Try using Nayya to find a provider that is in your network and the best choice for your procedure. 


Exclusive Provider Organization (EPO): This plan offers a decent amount of flexibility in choice of providers and you don’t have to get a referral from a primary care provider to see another specialist. With an EPO, there is no coverage for out-of-network providers. If you were to see a provider that is not in your plan’s network, other than in an emergency, you will have to pay the whole cost yourself. EPO also offers a lower premium than the PPO that is usually offered by the same brand. 


Point-of-service Plan (POS): This plan combines the features from an HMO and PPO. This provides much more freedom to choose your providers and a primary care doctor who has to refer you to see a specialist. You can see both in-network and out-of-network providers, but the out-of-network providers will cause you to pay more. With this plan, you may also pay a higher deductible if you choose to see an out-of-network provider. When you visit an out-of-network provider, you will have to pay your bill and file a claim to your carrier. 


High Deductible Health Plan (HDHP): These may or may not come with a Health Savings Account (HSA). A High Deductible Plan can be an HMO, PPO, or POS. Because of the high deductible, you may pay less for your insurance. This plan does carry a higher out-of-pocket cost than other plans. When you reach your maximum out-of-pocket amount, the plan will cover 100% of your care. If it has an HSA, this account helps you pay for care. The money that you put into this account is not taxed. The doctors you can see depend on the type of High deductible plan you have. The premium of an HDHP is often lower compared to other plans. Usually a deductible for an individual is 1,400 and 2,800 for a family. Under this type of plan, the preventative care is free; even if you haven’t met your deductible. However, you must pay all your costs up to your deductible for all care besides preventative. But this cost can be covered by the money in your HSA.


Preferred Provider Organization (PPO): This plan also offers a decent amount of flexibility in choice of providers. You also do not have to get a referral from your primary care doctor to see a specialist. there is a higher out-of-pocket cost if you see an out-of-network provider. If you do choose to see an out-of-network provider, you will have to pay the provider yourself and file a claim to get the PPO plan to pay you back. 

This is a lot of information to consider. Using our platform, Nayya will take all of this necessary information into account and help you promote your health while protecting your wealth by finding you the most suitable plan, providers, and care.