Different Types of Health Plans: How They Compare?

 Different Types of Health Plans: How They Compare

The details can vary across plans. In addition, deductibles -- the amount you pay before your plan picks up 100% of your health care costs -- vary according to plan, generally with the least expensive carrying the highest deductible.

• Platinum: covers 90% on average of your medical costs; you pay 10%
• Gold: covers 80% on average of your medical costs; you pay 20%
• Silver: covers 70% on average of your medical costs; you pay 30%
• Bronze: covers 60% on average of your medical costs; you pay 40%
• Catastrophic: Catastrophic policies pay after you have reached a very high
  
  
  deductible ($8,150 in 2020).  Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.

You will also see insurance brands associated with the care levels. Some large national brands include Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.

Each insurance brand may offer one or more of these four common types of plans:

Take a minute to learn how these plans differ. Being familiar with the plan types can help you pick one to fit your budget and meet your health care needs. To learn the specifics about a brand's particular health plan, look at its summary of benefits.

Health Maintenance Organization (HMO)

An HMO delivers all health services through a network of healthcare providers and facilities. With an HMO, you may have:

• The least freedom to choose your health care providers
• The least amount of paperwork compared to other plans
• A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan; most HMOs will require a referral before you can see a specialist.

What doctors you can see. Any in your HMO's network. If you see a doctor who is not in the network, you'll may have to pay the full bill yourself. Emergency services at an out-of-network hospital must be covered at in-network rates, but non-participating doctors who treat you in the hospital can bill you.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Your plan may require you to pay the amount before it covers care except for preventive care.
• Copays and/or co-insurance for each type of care. A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%. These charges vary according to your plan and they are counted toward your deductible.

Paperwork involved. There are no claim forms to fill out.

Preferred Provider Organization (PPO)

With a PPO, you may have:

•  A moderate amount of freedom to choose your health care providers -- more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
• Higher out-of-pocket costs if you see out-of-network doctors vs. in-network providers
• More paperwork than with other plans if you see out-of-network providers.