What Types of Health Care Insurance Do You Need?

Health care insurance helps pay a portion of your medical expenses. How much it pays and how you pay via copays, deductibles and coinsurance depends on the details of your policy.

There are various healthcare plans available, each tailored to a different need. Research the different options and their pros and cons so you can determine which is best suited for you.

Bronze and Catastrophic Plans

If you don’t qualify for Marketplace subsidies or don’t plan to use your health insurance often, Bronze plans might be a better option. They typically have lower monthly premiums than Silver plans and typically offer additional savings through cost-sharing reductions.

These plans feature higher deductibles than other metal tiers, but you’ll pay less out-of-pocket when you require medical care. They’re especially appealing for healthy young adults under 30 who cannot afford more costly options.

In 2021 and 2022, The American Rescue Plan will extend premium subsidies to more enrollees than ever before, making subsidized bronze plans the more advantageous choice for most people over catastrophic plans that don’t qualify for tax subsidies and cannot be used by most to purchase one.

Silver Plans

Silver plans in both individual/family and small group health insurance markets typically cover 70% of enrollees’ healthcare costs, including deductibles, copayments and coinsurance.

Silver plans may cost more or less than their Gold counterparts, depending on the actuarial value and financial assistance available. Fortunately, the American Rescue Act of 2021 has created premium subsidies which may make these plans more accessible.

Gold and Platinum Plans

Gold and platinum plans represent the pinnacle of coverage provided by insurance companies in both individual and small group markets. Though they tend to be the most costly health care insurance plans, they also provide the most comprehensive benefits and cost-sharing.

The Affordable Care Act established four metal-level categories for individual and small group health plans: bronze, silver, gold, and platinum. Each level has its own set of costs-sharing differences that could affect how much you pay in healthcare during a plan year.

Generally, bronze and silver plans offer lower premiums than gold and platinum plans but higher out-of-pocket expenses when receiving medical care. When selecting a health care insurance plan, these distinctions should be taken into account.

HMOs

Health maintenance organizations (HMOs) are a type of managed care health insurance plan that offers medical care at a fixed prepaid fee. By combining financing and care delivery, these HMOs aim to align financial incentives with care quality measures.

HMOs typically require you to select a primary care physician. This doctor will diagnose if you require treatment and refer you to appropriate specialists.

However, this doesn’t guarantee an in-network experience; some out-of-network doctors may still be covered but at a higher cost than going with one of the network providers.

HMOs are the most prevalent form of managed care, but there are other options to consider as well. You might want to look into a preferred provider organization (PPO), which offers more flexibility and options than an HMO does.

PPOs

A Preferred Provider Organization (PPO) is a managed care health plan that adheres to certain guidelines in order to keep costs low. They negotiate fees and schedules for services with healthcare professionals and facilities on behalf of their members.

Participants in these plans have access to discounted medical care or emergency visits, depending on their plan. Furthermore, participants may be allowed to visit out-of-network providers at a higher cost according to a reasonable and customary fee schedule.

If your workforce includes a high number of employees who visit specialists frequently, a PPO might be worth considering for your business. On the other hand, if the workers are younger and don’t visit specialists often, an HMO could be better suited to meet the needs of your company. It’s essential to comprehend the distinctions between these two plans so you can decide which is best suited to you and your operations.