4 Types of Health Plans: How They Compare

You have choices when you shop for health insurance. If you're buying from your state's Marketplace or from an insurance broker, you'll choose from health plans organized by the level of benefits they offer: bronze, silver, gold, and platinum. Bronze plans have the least coverage, and platinum plans have the most. If you are under 30, you may also be able to buy a high-deductible, catastrophic plan.

How are the plans different? Each one pays a set share of costs for the average enrolled person. The details can vary across plans.

• Platinum: covers 90% on average of your medical costs; you pay 10%
• Gold: covers 80% on average of your medical costs; you pay 20%
• Silver: covers 70% on average of your medical costs; you pay 30%
• Bronze: covers 60% on average of your medical costs; you pay 40%
• Catastrophic: Catastrophic policies pay less than 60% of the total average cost of care.  Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.

You will also see insurance brands associated with the care levels. Some large national brands include Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.

Each insurance brand may offer one or more of these four common types of plans:

• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Point-of-service (POS) plans
• High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)

Take a minute to learn how these plans differ. Being familiar with the plan types can help you pick one to fit your budget and meet your health care needs. To learn the specifics about a brand's particular health plan, look at its summary of benefits.

Health Maintenance Organization (HMO)

An HMO delivers all health services through a network of healthcare providers and facilities. With an HMO, you may have:

• The least freedom to choose your health care providers.
• The least amount of paperwork compared to other plans.
• A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan. Most HMOs will require a referral before you can see a specialist.

What doctors you can see. Any in your HMO's network. If you see a doctor who is not in the network, you'll have to pay the full bill yourself. Emergency services at an out-of-network hospital must be covered at in-network rates, but non-participating can doctors who treat you in the hospital can bill you.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services.
• Copays and/or co-insurance for each type of care.

Paperwork involved. No claim forms.

Preferred Provider Organization (PPO)

With a PPO, you may have:

• A moderate amount of freedom to choose your health care providers -- more than an HMO. You do not have to get a referral from a primary care doctor to see a specialist.
• Higher out-of-pocket costs if you see out-of-network doctors.
• More paperwork than with other plans if you see out-of-network providers.

What doctors you can see. Any in the PPO's network. You can see out-of-network doctors, but you'll pay more.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Some PPOs may have a deductible. You will likely have to pay a higher deductible if you see an out-of-network doctor.
• Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%.
• Other costs: If your doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.

Paperwork involved. There's little to no paperwork with a PPO if you see an in-network doctor. If you use an out-of-network provider, you'll have to pay the provider. Then you have to file a claim to get the PPO plan to pay you back.

Point-of-Service Plan (POS)

A POS plan blends features of an HMO with a PPO. With POS plan, you may have:

• More freedom to choose your health care providers than you would in an HMO
• A moderate amount of paperwork if you see out-of-network providers
• A primary care doctor who coordinates your care and who refers you to specialists

What doctors you can see. You can see in-network providers your primary care doctor refers you to. You can see out-of-network doctors, but you'll pay more.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services.You may pay a higher deductible if you see an out-of-network provider.
• Copays or coinsurance: You will pay either a copay, such as $15, when you get care or coinsurance, which is a percent of the charges for care.  Copayments and coinsurance are higher when you use an out-of-network doctor.

Paperwork involved. If you go out-of-network, you have to pay your medical bill. Then you submit a claim to your POS plan to pay you back.

High-Deductible Health Plan With or Without a Health Savings Account

You may be able to pay less for your insurance with a high-deductible health plan. With an HDHP, you may have:

• One of these types of health plans: HMO, PPO, or POS
• Higher out-of-pocket costs than many types of plans, but if you reach the maximum out-of-pocket amount, the plan pays 100% of your care
• A health savings account (HSA) to help pay for your care. The money you put in an HSA is not taxed and can be used tax-free on eligible medical expenses.

W hat doctors you can see . This varies depending on the type of plan -- HMO, POS, or PPO

What you pay.

• Premium: An HDHP has the lowest premium compared to other plans.
• Deductible: The deductible is high – in 2015, deductibles for individual health plans range between $1,300 and $6,450 for one person or between $2,600 and $12,900 for a family. Like with HMOs and PPOs, your preventive care is free even if you haven't met the deductible.
• Copays or coinsurance:  You must review your plans benefits carefully to learn what you will pay when you go for medical care.

With an HDHP, your out-of-pocket spending is capped. For instance, if you have insurance only for yourself, the most you have to spend in a year is about $6,450, not including premiums. If our insurance plan is for your family, the most you have to pay in a year is about $12,900 without premiums. The totals include your deductible. If you reach this amount, the plan pays 100% of your care.

Paperwork involved. The amount of paperwork varies, depending on whether you get care from a PPO, HMO, or POS plan. Keep all your receipts so you know when you've met your deductible.