There are different types of plans available. Your employer will offer you a few choices. These are also available through the public health insurance marketplace. Depending on where you live, many or all of these types may be in each ACA metal level.
The traditional fee-for-service plan offers the most flexibility but comes with higher premiums and out-of-pocket expenses. You choose your own hospital and doctors. There is typically a deductible and you are responsible for copays of about 20% of “reasonable and customary” medical expenses.
Health maintenance organizations, or HMOs, are the most cost-effective and least flexible option. Pay a monthly premium and all of your medical care and services through the HMO are covered. You’ll only have to pay a low-copayment per visit to use in-network providers. You must choose a primary care physician and may need a referral to see a specialist.
Point-of-service, or POS, plans are more flexible than HMOs but usually require you to select a primary care physician. With this option, you can see a doctor outside the network, although the amount covered by insurance will be substantially less.
Preferred provider organizations, or PPOs, are kind of a compromise between traditional fee-for-service plans and HMOs. You have control over your choice of doctors (including specialists), hospitals and pharmacies within a network of providers. If you stay within the network, you’ll pay a small copay. If you go out of network, there is usually a deductible and only 80% of the “reasonable and customary” costs are covered.
Exclusive provider organization, or EPO, only allows you to get services from doctors, hospitals and other providers within its network — except in an emergency.
Go to healthcare.gov for more information on the plans offered through the Affordable Care Act.
