Individual Health Insurance Plans
Health coverage for an individual is relatively easy to plan because there is only one person to consider. Individual health insurance plans use several types of medical networks and it will help you to learn about each: HMOs, PPOs, POSs, and new Health Savings Accounts. The different characteristics of each network can affect which individual insurance you ultimately choose.
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Individual HMO Health Insurance Plans
HMOs, or Health Maintenance Organizations, offer health care from a network of health care providers. HMOs tend to have respectable premiums and deductibles, but offer limited flexibility for choosing doctors and hospitals. Under an HMO plan, you need a referral from your primary care physician to see a specialist and you may have to pay 100% of cost if you see a doctor out-of-network.
Individual PPO Healthcare Plans
PPOs, or Preferred Provider Organizations, also have affordable premiums and deductibles – however, they offer more flexibility to see any doctor you want and don’t require a referral from your primary care physician to see a specialist (as is required from an HMO). Under a PPO, out-of-network costs are covered, but at a lower rate than in-network costs.
Individual High Deductible Healthcare Plans
High Deductible Health Plans, tend to have lower premiums than both HMOs and PPOs, but much higher deductibles. Deductibles are the out-of-pocket expenses you have to pay before insurance starts to cover you. You can use an HSA to lessen the financial burden of covering the high deductibles. These plans generally have similar flexibility to PPO plans.
Individual Health Savings Account
HSAs, or Health Savings Accounts, are growing in popularity for a variety of reasons. Though they may not be for everyone, if you can afford to put up the money up front, you can benefit from tax savings, and people typically save a decent chunk of money when all is said and done because they don't have to pay the expensive premiums.
Essential Health Benefits for Individuals
Every single health insurance marketplace and private health insurance plan sold must cover the following essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
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