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Types of Health Insurance Plans

All types of health insurance plans are compliant with the Affordable Care Act (the law commonly known as Obamacare) as are major medical health insurance plans. Different types of major medical health insurance plans include:

• Obamacare health insurance plans for persons and families
• Employer-based health insurance program
• Qualified Health Plans (these are Obamacare plans that can be bought with a subsidy)
• Catastrophic Plans (primarily accessible to people under age 30)
• Government-sponsored health insurance plans (Medicare, Medicaid, etc.)

Other types of health insurance plans that do not qualify as primary medical health insurance include:

• Short-Term Health Insurance
• Gap Insurance (Accident, Telemedicine, and Critical Illness)

Most people in the U.S. get private health insurance from their employer or union. Others obtain it from the government through Medicaid or Medicare.

Regrettably, some are uninsured.

The rest typically purchase their health plan through a government-run health insurance marketplace, a private online health insurance marketplace, or through a local broker or agent.

Obamacare necessitates every person to have a major medical health insurance policy or pay a tax penalty for being uninsured.

Whether you’re buying health insurance for the first time, wondering if you should change your health plan as your wants change, getting ready for the next Obamacare open enrollment period, or becoming qualified for a particular enrollment period because of a significant life change—you’ll need to take a look at the major types of health insurance available.

Types of Health Insurance Plans

Under the ACA, medical plans must provide minimum essential coverage, meaning that no one can be turned down for a plan during the Open Enrollment Period for medical reasons, including pre-existing conditions. Additionally, certain services and treatments must be provided in all health plans, irrespective of where you shop or what insurance company.

EPO, HMO, and More

Obamacare-compliant major medical health insurance plans come in numerous different formats, as described below:

Health Maintenance Organization (HMO) plans: HMOs are among the most common types of health insurance you can buy. With this plan, a whole network of health care providers agrees to offer you its services. You have to choose a primary care provider (PCP), who coordinates all of your health services and care.

HMOs usually provide coverage for most types of preventive care and specialist visits, but specialist visits are only covered when your PCP makes a referral. You will also pay copayment fees for every non-preventive medical appointment, and you may have an annual deductible. HMOs are usually best suited for individuals and families who plan to see their primary care doctor regularly for check-ups and other health concerns. Since 2014, the popularity of HMO plans has increased considerably.

Exclusive Provider Organization (EPO) plans: With an EPO plan, you have access to all healthcare providers within the EPO network and specialists. Whereas PPO plans may provide you some coverage outside of your network, EPO plans typically will not (except for emergencies). EPO plans can be suited well to people who do not mind limiting themselves to providers within a network and who don’t want to coordinate their care through a primary care doctor. Since 2014, the popularity of EPO plans has improved.

Short-term health insurance programs: Short-term health insurance plans do not act per Obamacare law. Nevertheless, if you missed the Obamacare open enrollment period, short-term health policy can offer you some level of coverage in the meantime.

Short-term insurance provides more limited benefits than major medical but can help safeguard your finances in the case of a covered illness or accident. The downside to this form of coverage is that it does not meet the minimum essential coverage needed by the Affordable Care Act, so you may also be subject to the tax penalty.

Additionally, short-term plans can exclude coverage for pre-existing conditions. Short-term insurance is non-renewable and does not include coverage for preventative care like vision, dental, vaccines, and physicals.

Resources and References:

• Types of Health Insurance Plans
• Exclusive Provider Organization (EPO) Plans