Common health insurance plans in the United States

There are many health insurance plans in the U.S. Different insurance plans give policyholders different choices and freedom of access to health care, and the cost of coverage varies accordingly. Learn about the features and differences of different health insurance plans to help you choose the right one.

FFS: Fee for Service
Traditional U.S. Medicare is a fee-for-service plan. There are no restrictions on the choice of hospitals or doctors, and the insured can choose to go to any hospital or clinic at any time. FFS plans are flexible, but more expensive.

Managed Care
Most private health insurance companies in the U.S. today are Managed Care. Managed care insurance companies also control the medical practices of providers (doctors, hospitals, etc.) to prevent doctors from abusing medical services for their own benefit. Managed care insurance helps to reduce overall medical costs, but may also affect the timeliness of patient access to medical services.

Controlled line health insurance is divided into the following four categories.
1. HMO: Health Maintenance Organization
HMOs are usually one of the most common plans, but also the most demanding type of plan. If you are enrolled in an HMO plan, you will be assigned to a Primary Care Physician “family doctor” within the medical network. Premiums for HMO plans are usually lower than other types of insurance plans.

2. PPO: Preferred Provider Organization
PPO is also one of the most common insurance plans that does not require a specific family doctor to be selected. The term “Preferred” means that it is best to choose a doctor or medical institution that is in-network with the insurance company, so that you can enjoy more member discounts and the insurance company will pay for a larger portion of your medical expenses. PPO insurance plans give the insured more choice, but the premiums are usually higher than HMOs.

3. EPO: Exclusive Provider Organization
EPO health plans are in between PPOs and HMOs, and usually require members to seek medical treatment at an in-network facility designated by the insurance company, but generally do not require a designated family doctor and can also see a specialist directly. Also EPO insurance plans only reimburse medical expenses incurred within their provider network, not those incurred outside the network. Premiums are usually higher than HMOs but lower than PPOs.

4. POS: Point-of-Service Organization
Like HMOs, POS members are assigned to a family physician. POS members can also go to out-of-network specialists or providers, but the insured will have to pay a higher deductible; POS has the advantage of lower premiums for HMOs and gives members more choice in their own care.

HAS: Health Saving Account
The HAS Health Saving Account is not an insurance plan, but a tax-free savings account for medical expenses. If you have an insurance plan with a high deductible, you can open a Health Saving Account and use it to save tax-free and use the funds to pay for your medical expenses. Funds deposited into the HAS account are 100% tax deductible, but there are limits on the amount that can be deposited each year.

The Affordable Care Act requires that everyone have health insurance. There are some additional factors to consider when shopping for a health insurance plan if you fit into one of the following categories.

1. Family health insurance
If there are children in the family, they are more likely to go to the hospital or even to the emergency room than adults. Make sure that the Deductible, Copayment and Coinsurance of your plan are affordable. You should also be aware that family health insurance plans usually have a deductible for each person and a deductible for the entire family. The insurance plan will only share medical expenses for that family member after the individual deductible is paid up, and Medicare will only share medical expenses for each family member (even if his or her individual deductible is not used up at that time) when the deductible for the entire family is paid up.

2. As a student
If your parents have family members who are also in the U.S. and have health insurance, you can remain on your parents’ health insurance plan until you turn 26. However, if you are an international student or you are studying out of state (your parent’s network may not be available in the state where you are attending school), purchasing group health insurance through your school is usually the easiest and most economical way.

3. Freelance/self-employed
Employers usually have a partner insurance company and can sign up for Group Health Insurance directly with the company. For freelancers or self-employed, you have to purchase individual health insurance on your own. a) Make sure your premiums are affordable, especially for freelancers or start-ups with irregular monthly income; b) Health insurance premiums are tax deductible, so Don’t forget to tell your accountant about this cost when you file your annual tax return; c) Also, if you travel a lot, give preference to plans that include out-of-network providers, such as PPO or POS plans.

4. Low Income Households
If the household does not have a high income or a low budget for health insurance, it is recommended that you see if you qualify for Medicaid. If your income is between 100% and 400% of the poverty line as published by the federal government, you will be able to apply to receive government subsidies for health insurance. For low-income families, Medicare is even more important because any family member health problems can become a financial crisis for the entire family.

5. Over 65 years old
Seniors who are 65 years of age or older with citizenship/green card status are eligible to apply for Medicare “red and blue cards”, while seniors can also purchase supplemental insurance or apply for a Medicaid “white card” to cover the out-of-pocket expenses.