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Imagine choosing a marketplace insurance plan because it’s the cheapest. Soon you realize that you may have done better if you choose from plans with other network types.

Before you focus on cost alone, consider the different types of health insurance plans. That way, you can make sure the plan you select will meet your needs.

Read on to learn more.

Preferred Provider Organization (PPO)

Like Medicare plans, you can choose from different types of health plans on the marketplace. A preferred provider organization (PPO) has a network of doctors and hospitals you can visit.

When you go to those doctors, you will pay less than if you visited someone outside of the plan’s network. You have the option to visit doctors outside of the network, but you may need to pay for some of your care.

Advantages

PPOs are more flexible than other network types of health insurance. They’re good if you know which doctors or hospitals you like to visit, even if they aren’t in your plan’s network.

These plans come at all four metal levels, from bronze to platinum. That means you may be able to save money on your premiums if you select a plan with a higher deductible.

A PPO usually covers more services than some other types of plans.

Disadvantages

If you enroll in a PPO, you can expect to pay a higher premium for the same deductible or network as a different plan type. You have more flexibility and more coverage, and that will cost you.

The plan might also have different deductibles for in-network and out-of-network services. If you don’t like dealing with numbers, it can be hard to calculate everything.

Exclusive Provider Organization (EPO)

An exclusive provider organization (EPO) is similar to a PPO because you can receive care in or out of your network. However, an EPO will only help with the cost of care in your network.

The exception to that is in an emergency, where your insurance company must cover your care. If you choose to see a doctor for routine care out of your network, you will have to pay for the visits.

Advantages

The most significant advantage of an EPO is the ability to save money on your premiums. If you’re deciding between an EPO and PPO with the same level of care, the EPO will probably cost you less each month.

You can also look for an EPO that doesn’t require referrals. Then, you’ll have the option of seeing doctors in or out of network, so you get to decide if the cost of going out of your network is worth it.

Disadvantages

While you can go out of your network with an EPO medical insurance plan, it will cost you. A PPO may help cover the cost of out-of-network services that you choose, but you’ll be responsible for that cost with an EPO.

Another disadvantage for some people is that EPOs tend to have high deductibles. If you have frequent medical expenses, such as doctor visits or prescriptions, you may need to pay more than you expect.

Health Maintenance Organization (HMO)

A health maintenance organization (HMO) is similar to an EPO in that you have to stay in-network for insurance to cover part of your health care costs.

You have to work or live in the area to qualify for coverage through an HMO. When you enroll in an HMO, you will want to find a primary care provider that you trust in the plan’s network.

Advantages

HMOs tend to have some of the cheapest health insurance premiums available. These plans may also have low deductibles or no deductible at all, so you will pay a co-pay when you receive care.

You may also get better care earlier on when you have an HMO. Your primary care doctor will encourage you to see a specialist if you have a serious problem.

On other plans, it may be easy to wait until you need to see a specialist since you don’t need a referral.

Disadvantages

You have to choose a primary care doctor before you can see anyone else. If that doctor doesn’t renew their contract with your insurance company, you’ll need to switch doctors.

HMOs may also not consider as many things to be emergencies. In that case, you’ll need to pay the entire cost of your care, even if you met a low deductible or if there is no deductible.

Point of Service (POS)

A point of service (POS) plan is similar to some network types because you have to stay within your network. You can go out of network for care, but you may pay more if your primary care doctor doesn’t refer you.

If you go out of network, you will have to handle filing paperwork with your insurance company. These plans are like a mix between PPO and HMO plans, but they can be hard to find.

Advantages

POS plans can be more affordable than PPO and some EPO plans. You also have the option of going out of network without paying the full price if your doctor refers you.

If you stay in-network, with or without a referral, you can also save money. This is a good option for people on a tight budget who still need plenty of care.

Disadvantages

One disadvantage of a POS plan is that they’re not as common or available as other plans. If you like the plan but you move or your plan closes, you may not get the same type of coverage.

It may also be hard to understand what costs you do have. Plus, you’ll have to file your own claims when seeing doctors outside of your plan’s network.

Which Plan Network Types Will You Consider?

The different insurance network types offer unique pros and cons, and one type isn’t the best for everyone. Be sure to consider your budget, care needs, and other factors.

You should also think about your current doctors and if they’ll accept a different plan. Then, you can determine if the advantages outweigh the disadvantages of a particular plan.

Are you looking to compare types of Medicare plans along with marketplace insurance? Contact us to learn more.