Healthcare Education

PROVIDER NETWORKS

Health Maintenance Organization (HMO)

Exclusive Provider Organization (EPO)

HMO plans are county or state coverage. They usually limit coverage to providers who are within the plan's network, and require a doctor's referral to see specialists. Meaning if you need to go see a specialist, you need to first go to your primary care doctor who has a specific list of doctors they can refer.

Exclusive Provider Organization (EPO)

EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).

These networks are a little larger than the HMOs and you don't require a doctor's referral to see specialists!

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Preferred Provider Organization (PPO)

PPO are nationwide coverage outside of just your state. You receive a discount just for staying in network. These plans usually cover some of the cost of out-of-network providers (but not as much as for in-network providers), and you don't require a doctor's referral to see specialists!

A Point-Of-Service (POS)

Exclusive Provider Organization (EPO)

Preferred Provider Organization (PPO)

POS plan allows you to choose between in-network and out-of-network providers:

In-network: You'll pay less for care from doctors, hospitals, and other health care providers

Out-of-network: you'll usually need a referral from your primary care doctor and pay higher out-of-pocket costs

Public VS Private Market Insurance

The ACA (Affordable Care Act) was created back in 2010 to make sure anyone with pre-existing conditions would not be denied coverage. Also known as ObamaCare, Market Place, or Healthcare.gov.

These plans are also income based, which allows plans to be subsidized depending on the household income. So if you make a lower income the premiums for certain plans will be lowered.

You can only enroll in these plans during Open Enrollment (Nov 1st-Jan15th) or if you qualify for SEP (Special Enrollment Period), which is if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.

These are full comprehensive insurance plans

Private Underwritten Insurance plans were created at the end of 2009 right before the ACA started. These plans are medically underwritten for those who do not have major pre-existing conditions.

The insurance company is essentially mitigating their risk by accepting those individuals which allows the insurance company to offer lower premiums.

You are able to enroll in these policies year round if you can qualify.

These are full comprehensive insurance plans

Short-Term Plans

Limited Benefit Plans

These plans are geared toward those who need temporary insurance to bridge the gap between plans. They can provide coverage for up to 3 months.

Short-term plans may have lower premiums but often provide limited coverage and do not include all essential health benefits including no pre-existing conditions being covered.

These plans are NOT full comprehensive insurance plans

Short Term Plans:

Golden Rule (UnitedHealthcare), National General, Companion Life, Pivot Health, Everest Prime, LifeShield, Alliance, Standard Life, QualChoice, Advant

Limited Benefit Plans

These plans pay a predetermined amount of the bill with no out of pocket maximum or catastrophic coverage. Meaning if the plan covers $3,000 for a surgery, that is ALL they will cover. Anything over that dollar amount is your responsibility, no matter how high the remaining balance becomes.

Limited benefit plans are designed to be paired with a full insurance plan to cover cost they might not cover.

These plans are NOT full comprehensive insurance plans

Limited Benefit Plans:

Multiplan (PHCS), Humana-Protector, Chubb, Cardinal Choice, LifeShield, Agile, Allstate, Standard Life, OneCare, Legion/Axis

Health Sharing Plans

Limited Benefit Plans

Health Sharing Plans

Health sharing plans, also known as medical cost-sharing programs, involve a group of individuals who share medical expenses. Members contribute monthly payments, which are then used to cover each other's eligible medical costs. Health sharing plans often have specific eligibility requirements and may not provide coverage for certain conditions or

These plans are NOT full comprehensive insurance plans

Health Sharing Plans:

Christian Healthshare Ministries, Medi-share, Liberty Healthshare, Zion Health, One Share Health, Trinity Healthshare

Supplement Plans

Health Sharing Plans

Supplemental plans, also known as ancillary or gap plans, are designed to complement existing health insurance coverage. These plans provide additional benefits or coverage for specific services, such as dental, vision, or prescription drugs. Supplemental plans can help fill gaps in coverage and reduce out-of-pocket expenses for specific healthcare needs

Employer Plans

Supplement Plans

Employer Plans

Employer-sponsored health insurance plans are provided by employers to their employees as part of their employee benefits package. These plans vary in terms of coverage and benefits, and the cost of premiums is often shared between the employer and the employee. Employer plans may offer a range of options, including different levels of coverage and network

Cobra Plans

Supplement Plans

Employer Plans

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows eligible individuals to continue their employer-sponsored health insurance coverage for a limited period after leaving their job. COBRA plans provide continuity of coverage but typically require the individual to pay the full premium

Medicaid VS Medicare

Medicaid

Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. Eligibility and benefits vary by state, but Medicaid generally covers essential medical services, including doctor visits, hospital stays, preventive care, and some long-term care services.

To get information towards your states program you can search it on google and call them directly!

Medicare

Medicare is a federal health insurance program primarily designed for individuals aged 65 and older, although it also covers certain younger individuals with disabilities. It has four parts:

Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.
Part C (Medicare Advantage): Offers an alternative to Original Medicare, providing Part A and Part B benefits through private insurance companies approved by Medicare.
Part D (Prescription Drug Coverage): Helps cover the cost of prescription

Insurance 101

PROVIDER NETWORKS

Health Maintenance Organization (HMO)

Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Preferred Provider Organization (PPO)

A Point-Of-Service (POS)

Exclusive Provider Organization (EPO)

Preferred Provider Organization (PPO)

Public VS Private Market Insurance

Short-Term Plans

Limited Benefit Plans

Limited Benefit Plans

Limited Benefit Plans

Limited Benefit Plans

Limited Benefit Plans

Health Sharing Plans

Limited Benefit Plans

Health Sharing Plans

Supplement Plans

Supplement Plans

Health Sharing Plans

Employer Plans

Supplement Plans

Employer Plans

Cobra Plans

Supplement Plans

Employer Plans

Medicaid VS Medicare

Medicaid

Medicare

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