There are several different types of insurance plans you can buy to get coverage for health and other care like routine vision or dental.
Employer-sponsored: This health insurance coverage is also called group or small group coverage. This is the type of health insurance you usually get through work. Group health insurance allows you to split the cost of your monthly premium with your employer, and you’ll pay other cost-sharing payments.
Individual and Family Plans: This health insurance is coverage you enroll in by yourself. These plans, also called Affordable Care Act (ACA) plans or Obamacare plans, are available to everyone. You can either buy them through your state or federal marketplace, health insurance companies, or brokers like eHealth.
Medicare: Medicare is a federal health insurance program that insures seniors aged 65+. Beneficiaries can choose to get their coverage through a private insurance company with a Medicare Advantage plan, also called Medicare Part C, or through the government. If they stick with Original Medicare, they can get extra coverage with a Medicare Supplement Insurance plan and prescription drug coverage through Medicare Part C. If you qualify for Medicare, you can find more information or shop for Medicare plans with eHealth.
Short-term: Enrolling in short-term, or temporary, health insurance plans can help bridge any gaps in coverage you may have for short periods of time (anywhere from a few months to 3 years in some states).
Dental: Most medical insurance does not cover routine dental care. In order to get insurance for things like cleanings or root-canals you’ll need to enroll in a separate dental insurance plan.
Vision: Most medical insurance does not cover routine vision care. In order to get insurance for things like eye exams, glasses, and contacts you’ll need to enroll in a separate vision plan.
Other: In addition to these most common types of health insurance, there are some other types of health insurance that either require special circumstances to qualify for or only cover specific needs (accident insurance, Medicaid, CHIP, etc.). Check out eHealth’s resource center to find out more about all health insurance plan types or contact a licensed agent with eHealth if you’re not finding what you’re looking for.
These abbreviations may be familiar to you since they’re thrown around a lot when talking about insurance, but what do they mean?
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are two of the most popular types of major medical health insurance plans. There are a few notable differences between HMOs and PPOs:
Primary Care Doctors and referrals: With an HMO you’ll have a primary care doctor who you (and your family) will go to for most health care needs. If you want to see a specialist, you must get a referral from your primary care doctor. You also cannot receive coverage for going out of network. With a PPO you do not need to name a primary care doctor, get a referral to go to a specialist, and you may have to pay more for out of network care.
Premium costs: HMOs tend to have lower premiums than PPOs – though this can differ from plan to plan.
Plan costs: With HMOs deductibles are rare and copays are usually minimal, though this can differ from plan to plan. PPOs may have deductibles and may have higher copays.
Filing claims: With HMOs you typically don’t have to file any claims yourself. With PPOs you may have to file some claims – especially if you go out of network for care.
When deciding between an HMO or a PPO it’s important to consider your budget but also your health care needs and preferences. For instance, if you’re on a tight budget an HMO may be a better option for you. However, if flexibility with your health care is important to you a PPO may be the right choice.
Making these decisions can be difficult and daunting considering you typically are locked into your plan for a full calendar year. If you’re having a hard time making a decision, or just need someone to talk through your options with, eHealth’s licensed insurance agents are here to help you make the right decision for your specific needs.
If you need help making the decision between an HMO or a PPO for your small business, eHealth can help with that too!
You may have seen these other acronyms when shopping for health insurance or looking through your benefits package through your job.
HSAs, or Health Savings Account, is a tax-advantaged account owned by an individual with a high deductible health insurance plan. Both the person on the account and their employer can contribute a certain amount of money to the account each year.
Cyber Insurance PoliciesHRAs, or Health Reimbursement Arrangements, are employer-funded plans where employees can be reimbursed by their employer for qualified medical expenses and insurance premiums. These are not bank accounts, they are an agreement between employee and employer.
Additionally, FSAs are a similar arrangement to HSAs, but the tax-advantaged account is connected to the employer rather than the employee.
Another notable difference between HSAs and HRAs is that because HSAs are owned by the employee, they stay with them even if they chose to leave their job. You can learn more about the differences between HRAs and HSAs in our more detailed article.
There is plenty of confusing health insurance industry jargon that you’re bound to encounter when you’re shopping for coverage. Let’s define some of these key terms:
Premium: Your premium is the amount of money you pay to your health insurance company each month to stay enrolled in your plan and keep your coverage.
Deductible: This is the amount of money you must pay out-of-pocket before your health insurance starts paying for health care services.
Copay: Copays are types of cost sharing payments you may have to make out-of-pocket when you receive certain health care services or medications. They’re typically a flat rate; for example, $10 per doctor’s visit or $15 for certain medications.
Copay: Copays are types of cost sharing payments you may have to make out-of-pocket when you receive certain health care services or medications. They’re typically a flat rate; for example, $10 per doctor’s visit or $15 for certain medications.
Coinsurance: Coinsurances are another type of cost sharing payment you may have to make out-of-pocket when receiving certain health care services or Medications. These are usually in the form of a percentage. For instance, let’s say you have a 10% coinsurance for a doctor’s visit that costs $100. You will pay $10 for every $100 your insurance pays for a doctor’s visit.
Out-of-pocket maximum: This is a cap on how much you’ll have to pay out of pocket for health care in one year. After you reach this amount your insurer will pay for your covered care in full for the rest of the year. For example, if you have a $44,000 out-of-pocket limit and you’ve met your $4,000 deductible and paid $40,000 in other cost-sharing payments (like copays or coinsurances), you’ve met your limit and your insurance company will pay for any covered care for the rest of the year. Affordable Care Act compliant plans require all major medical health insurance plans to have an annual out-of-pocket maximum for each beneficiary.
Every health insurance plan is categorized by different metal ratings based on how much coverage they offer. There are 5 levels of coverage you can get with an ACA plan:
Bronze: You can expect to pay 40% of the costs for covered care with your plan paying 60%, these plans have the highest out-of-pocket costs with the lowest premiums.
Silver: You can expect to pay 30% of the costs for covered care with your plan paying 70%, these plans have high out-of-pocket costs with low premiums.
Gold: You can expect to pay 20% of the costs for covered care with your plan paying 80%, these plans have low out-of-pocket costs with high premiums.
Platinum: You can expect to pay 10% of the costs for covered care with your plan paying 90%, these plans have the lowest out-of-pocket costs with the highest premiums.
Catastrophic coverage: In addition to the 4 metallic levels of coverage, you may have the choice to get a plan with catastrophic coverage. Catastrophic coverage is a type of coverage available to those under 30 or those who qualify for a “hardship exemption”. They are designed to protect you in a worst-case scenario, hence the name “catastrophic” coverage. These plans have very high-deductibles and low premiums.
The cost for health insurance plans varies greatly depending on the type of plan and level of coverage. Even if you stay with the same health insurance plan year after year, you can expect the cost of your plan to change yearly.
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