Health Insurance is important when you are living in this economy with high medical rates. If you’re buying from your state’s Marketplace or from an insurance broker, you’ll choose from health plans organized by the level of benefits they offer bronze, silver, gold, and platinum.
How are plans different?
Each one pays a set share of costs for the average enrolled person. The details can vary across plans. In addition, deductibles are the amount you pay before your plan picks up 100% of your health care costs vary according to plan, generally with the least expensive carrying the highest deductible.
Platinum: covers 90% on average of your medical costs; you pay 10%
Gold: covers 80% on average of your medical costs; you pay 20%
Silver: covers 70% on average of your medical costs; you pay 30%
Bronze: covers 60% on average of your medical costs; you pay 40%
Catastrophic: Catastrophic policies pay after you 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 you have not yet met your deductible.
Types of Health Insurance
Each insurance brand may offer one or more of these four common types of plans:
Health maintenance organizations (HMOs)
The least freedom to choose your health care providers
The least amount of paperwork compared to other plans
A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan; most HMOs will require a referral before you can see a specialist.
Preferred provider organizations (PPOs)
A moderate amount of freedom to choose your health care providers — more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
Higher out-of-pocket costs if you see out-of-network doctors vs. in-network providers
More paperwork than with other plans if you see out-of-network providers
Exclusive provider organizations (EPOs)
A moderate amount of freedom to choose your health care providers — more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
No coverage for out-of-network providers; if you see a provider that is not in your plan’s network – other than in an emergency – you will have to pay the full cost yourself.
Lower premium than a PPO offered by the same insurer
Point-of-service (POS) plans
More freedom to choose your health care providers than you would in an HMO
A moderate amount of paperwork if you see out-of-network providers
A primary care doctor who coordinates your care and who refers you to specialists
High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)
One of these types of health plans: HMO, PPO, EPO, or POS
Higher out-of-pocket costs than many types of plans; like other plans, if you reach the maximum out-of-pocket amount, the plan pays 100% of your care.
A health savings account (HSA) to help pay for your care; the money you put in an HSA is not taxed and can be used tax-free on eligible medical expenses. In order to have an HSA, you must be enrolled in an HDHP.
Many bronze plans may qualify as HDHPs depending on the deductible
