Topic Area:  

  • Your options and why you need coverage

What types of health plans are available?

As you are look at your insurance options, you may notice different types of health plans. What do all those initials mean?

  • Health Maintenance Organization (HMO) -- This type of plan usually requires you to use only providers who are contracted directly with the health plan who are also referred to as in-network providers. You are typically required to choose one physician, physician assistant or nurse practitioner to serve as your primary care provider.  Your primary care provider will serve to administer most of your preventative care and manage and coordinate additional care through referrals to specialists and other health care professionals.
  • Exclusive Provider Organization (EPO) -- An EPO works in a similar fashion to a HMO, enrollees must use network providers - doctors, hospitals and other healthcare providers - that participate in the plan.  The only exception is for emergency care.  Unlike an HMO, enrollees do not need to select a primary care provider nor do they need to contact their primary care provider for referrals to specialists.  It is especially important that members of an EPO to check with their plan by phone or website to be sure the provider is in network.
  • Point of Service (POS) -- This type of plan is an HMO with a feature that allows you to access out-of-network services with higher cost sharing.   Your cost share is less when you use in-network providers.
  • Preferred Provider Organization (PPO) -- This type of policy allows you to choose whether to use an in-network or out-of-network provider each time you receive care. Your cost sharing is best when you use in-network providers.
  • Indemnity -- Traditional indemnity plans (also called "fee for service") insurance is a type of plan where there is no network of doctors; the plan pays the Usual or Reasonable and Customary fee for the service in your geographic area. Under this type of plan, you may pay up front for your care and receive reimbursement from your insurance company for some or all of your doctor's bills. These plans are now less common.

High Deductible Healthcare Plans

High deductible health plans (HDHP) have a high deductible (the Internal Revenue Service sets the minimum deductibles and limit on out-of-pocket maximums allowed for these types of plans each year). These types of plans are often paired with individual health savings accounts. Learn more. 

Government Programs

Medicare coverage is available for those 65 and older or for those with certain qualifying diseases.

  • Medicare A covers hospital costs learn more 
  • Medicare B covers doctor and outpatient costs learn more 
  • Medicare Advantage plans are managed Medicare plans, meaning the plan provides meaning the plan provides hospital, doctor, and outpatient benefits. Some plans include drug coverage. Learn more 
  • Medicare D provides pharmaceutical coverage for those eligible for Medicare learn more 

Medicaid programs provide a variety of programs for those who meet eligibility criteria learn more  or call 800-852-3345, ext. 4344 or 603-271-4344.

Health Exchange (Marketplace) plans offer subsidized health insurance for eligible individuals. learn more 

Knowing the types of insurance plans that are available can help you choose the one that fits best for your healthcare and budget requirements.

4/9/2018