Catastrophic: Catastrophic policies pay after they have reached a very high deductible ($8,700 in 2022). Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if they have not yet met their deductible.
Platinum
Covers 90% on average of the medical costs; they pay 10%
Gold
Covers 80% on average of the medical costs; they pay 20%
Silver
Covers 70% on average of the medical costs; they pay 30%
Bronze
Covers 60% on average of the medical costs; they pay 40%
Health maintenance organizations (HMOs)
An HMO gets all of its health services from a network of doctors, hospitals, and other health care providers. They may have less provider choice and less paperwork than other plans, and require a reference before they may see a specialist. A primary care doctor will supervise their treatment and refer them to specialists as needed.
What They Need To Pay
- Their plan may require you to pay the amount before it covers care except for preventive care.
- A copay is a flat fee, such as $15, that they pay when they get care. Coinsurance is when they pay a percent of the charges for care, for example 20%. These charges vary according to their plan and they are counted toward the deductible.
Exclusive provider organizations (EPOs)
– For this plan, they may have a little more freedom than with an HMO to choose their health care providers. They also don’t need a referral from their primary care doctor to see a specialist.
– No coverage for out-of-network providers and Less expensive than a PPO from the same insurance company.
What They Need To Pay
- Some EPOs may have a deductible.
- A copay is a flat fee, such as $15, that they pay when they get care. Coinsurance is when they pay a percent of the charges for care, for example 20%. These charges vary according to their plan and they are counted toward the deductible.
- If they go to a doctor who is not in their network, they will have to pay the whole bill.
Preferred provider organizations (PPOs)
For this plan, they may have a little more freedom than with an HMO to choose their health care providers. They don’t need a referral from your primary care doctor to see a specialist.
If they go to an out-of-network doctor instead of an in-network doctor, they will have to pay more out of pocket and fill out more paperwork than with other plans.
If they go to a doctor who is not in their network, they have to file a claim so that the PPO plan will pay them back.
What They Need To Pay
- There may be a deductible with some PPOs. If they go to a doctor who is not in their insurance network, they will probably have to pay a higher deductible.
- A copay is a flat fee, such as $15, that they pay when they get care. Coinsurance is when they pay a percent of the charges for care, for example 20%. These charges vary according to their plan and they are counted toward the deductible.
- If their doctor who is not in their insurance network charges more than other doctors in the area, they may have to pay the difference after their insurance pays its share.
Point-of-service (POS) plans
A POS plan has parts of both an HMO and a PPO. For this plan, they may have more freedom to choose their health care providers, Moderate paperwork load if they see an out-of-network provider, and a primary care doctor who coordinates their care and who refers them to specialists
What They Need To Pay
- Their plan may require them to pay a deductible before it will pay for care that isn’t preventive. If they see a doctor who is not in their insurance plan’s network, they may have to pay a higher deductible.
- They will either pay a copay, such as $15, or coinsurance, which is a percentage of the cost of care. When they go to a doctor who is not in their insurance plan’s network, their copayments and coinsurance will be higher.
- For paperwork, If they go to a doctor who is not in their network, they have to pay the bill. Then send their POS plan a claim to get their money back.
High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)
Similar to a catastrophic plan, a high-deductible health plan may let you pay less for your insurance (HDHP). If you have an HDHP, they may have one of these types of health plans: HMO, PPO, EPO, or POS, many types of plans have lower out-of-pocket costs than this one, but once they reach the maximum out-of-pocket cost, the plan pays for all of the care, the money they put in an HSA is not taxed and can be utilized tax-free on qualified medical costs. An HDHP is required for an HSA, and depending on the amount of the deductible, many bronze plans may be HDHPs.
What They Need To Pay
- For premium, an HDHP has a lower premium than other plans.
- In 2022, the minimum deductible for an individual is $1,400 and the minimum for a family is $2,800. The maximum deductible for an individual is $7,050 and the maximum for a family is $14,100. Even if they haven’t met their deductible yet, preventive care is always free, no matter what plan you have.
- When they go to the doctor for anything other than preventive care, they have to pay for all of the costs up to their deductible. They can pay for these costs with money from their HSA.
Catastrophic Plan
They can buy a catastrophic health plan if they are under 30. If they have a catastrophic health plan, they could have lower premium, 3 primary care visits before the deductible applies, and free preventive care, even if they haven’t met the deductible.
What They Need To Pay
- A catastrophic health plan has a deductible of $8,700 for an individual and $17,400 for a family in 2022. After you reach that deductible, the plan will pay 100% of your medical costs for covered benefits.
- You will want to keep track of your medical expenses to show you have met the deductible.