As you begin to look for private health insurance policies, you may quickly become overwhelmed by the sheer volume of different options that are available. Should you go with an HMO, or is a PPO more to your needs? What are the differences between an EPO and POS? The list of questions goes on and on.

But the most important thing to understand about all of this is that there is no "one size fits all" approach to what you're doing. If you really want to make sure that you're ending up with the best private health insurance policy, you'll want to consider your own needs and work your way back to the type of policy that meets them.

The Ins and Outs of Private Health Insurance and Medical Coverage

First, what is private health insurance? To put it simply, these are insurance policies that aren’t funded by taxpayer dollars. Plans like Medicare, Medicaid and Children’s health policies run by a state – these are primarily funded through taxpayer dollars. Whereas a private health insurance plan is covered by companies providing health insurance to their employees, or individuals purchasing their own insurance – your monthly premium, deductibles and co-pays are what covers the cost of insurance.

One of the most common types of private health insurance plans is called an HMO, or "Health Maintenance Organization." It is known for being one of the most affordable plan types there is. In addition to lower monthly premiums and deductibles, you also typically get to enjoy fixed copay for things like doctor visits as well. The downside, however, is you are required to have a primary care provider, often called a PCP (if you don’t pick one, you are assigned to one). If you need to see a specialist, you will need to see your PCP who will give you a referral to a specialist. If you see a specialist without the referral, the insurance likely won’t pay for it. This kind of plan also limits you to only using a provider in their network.

A PPO or "Preferred Provider Organization," on the other hand, is known for higher premiums - but also fewer restrictions. Not only can you see specialists that are out-of-network, but you typically don't need a referral in order to do so. Copays for doctor's visits that are in-network are typically lower than they would be with other plan types.

A POS is also commonly referred to as a "Point of Service" plan. Here, you'll likely need to get a referral from your primary care doctor in order to see a specialist of any kind.

However, while the monthly premiums will typically be higher than you could expect to pay with an HMO, you'll also likely get coverage for any doctor's visits that are out-of-network as well.

Finally, you have an EPO or "Exclusive Provider Organization." This is one of the less common medical coverage plan types out there, but it does come with a few distinct benefits. For starters, the networks that you're dealing with tend to be larger than others, but the care you get is exclusive to only that group of approved providers. You might need to get a referral to see a specialist, but this isn't always a guarantee. In terms of the amount of money that you'll pay on a monthly basis, this falls somewhere in between an HMO and a PPO. In fact, a lot of people tend to refer to this as a type of HMO/PPO hybrid.

Supplemental coverage can also be purchased through various providers, with dental care being the primary example. Note that thanks to the ACA (also called the Affordable Care Act or Obamacare), buying the healthcare you need through private insurance companies has never been easier.

Those interested in learning more about the ins and outs of private health insurance, or to find out which plan is best for you, give us a call today! We can help connect you with a licensed health insurance agent who can navigate you through all your options to find the best plan for you!