Understanding The Different Types Of Health Insurance Plans
The Three Basic Types Of Health Insurance Plans
Health insurance plans vary in coverage, cost, and availability of doctors in your network. By understanding the different types of medical insurance, you can select a plan that best fits your needs.
Below are the three most common types of health coverage and key details of each:
HMO (Health Maintenance Organization)
- Lowest monthly premiums
- Primary care provider selection required*
- Referral required to see a specialist*
- Only in-network providers and emergency visits are covered
EPO (Exclusive Provider Organization)
- Lower monthly premiums than PPO
- Primary care provider not required
- No referral required to see a specialist
- Only in-network providers and emergency visits are covered
PPO (Preferred Provider Organization)
- Highest monthly premiums
- Primary care provider not required
- No referral required to see a specialist
- Preferred in-network provider options, out-of-network care is covered but costs more
*Most Anthem HMO plan options do not require a PCP selection or referral to see specialists.
What Is An HMO (Health Maintenance Organization) Plan?
An HMO plan offers coverage for in-network doctors and hospitals, but will not cover out-of-network providers unless it is an emergency. The HMO model helps keep healthcare costs affordable for members.
An HMO may be right for you if:
- You plan on visiting doctors within the coverage network
- You want to pay less for monthly premiums and out-of-pocket costs
- You prefer a relationship with one doctor who can help manage your care and refer you to specialists as needed*
*Most Anthem HMO plan options do not require a PCP selection or referral to see specialists.
What Is A PPO (Preferred Provider Organization) Plan?
A PPO is a health plan with a “preferred” network of providers in your area and does not require a primary care provider (PCP) referral to see a specialist. A PPO health plan provides more choices but typically has higher monthly premiums. With a PPO plan, you can save money if you use doctors in the plan’s network. You can also use doctors, hospitals, and providers outside of the network but it will cost more.
A PPO plan may be right for you if:
- You prefer more freedom in your choice of doctors and hospitals
- You want to see specialists without a referral
- You have a doctor you already like and do not mind paying more in overall costs for a broader network of providers
What Is An EPO (Exclusive Provider Organization) Plan?
An EPO is a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are usually less expensive than a PPO. Like a PPO, you won’t need a referral to get care from a specialist. But similar to an HMO, you’ll be responsible for paying the costs for seeing a doctor outside of the plan’s network.
An EPO plan may be right for you if:
- You want more doctor and hospital options within your network
- You are looking for a health plan that offers the coverage you need with costs that fall between a PPO and an HMO
- You prefer to see a specialist without consulting with your primary care physician
Shop For Health Insurance Through Anthem
You can explore all of the health plans Anthem offers, including plans certified by the Marketplace. If you’re concerned you can’t fit health insurance into your budget, you can check if you are eligible for a health insurance subsidy, which is financial help from the government to help pay for your healthcare coverage. If you qualify, you may be able to lower or completely eliminate your premium.
Marketplace plans are available in four metal levels:
Bronze
- Lowest monthly premiums
- Higher deductibles
- For individuals and families who only need routine checkups, preventive care, and emergency care coverage
Silver
- Average monthly premiums
- Lower deductibles
- Additional cost-sharing subsidies may reduce out-of-pocket costs for eligible enrollees based on income
- For individuals and families who need routine preventive care along with coverage for a condition or upcoming procedure
Gold
- Higher monthly premiums
- Lower deductibles
- For individuals and families who need routine preventive care and have ongoing healthcare needs
Platinum
- Highest monthly premiums
- Lowest deductibles
- Coverage for nearly all healthcare costs
- For individuals and families with ongoing healthcare needs
Learn more about choosing a Marketplace health plan.
Get Help Navigating Your Health Insurance Options
Count on our experience and support to enroll in health coverage. We can help you choose a health insurance plan with Anthem and guide you through the process.
Find The Right Plan For You
Compare health insurance plans and find one that fits your needs.
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and AMGP Georgia Managed Care Company, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Community Care Health Plan of Nevada, Inc. and Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by either Matthew Thornton Health Plan, Inc. or Anthem Health Plans of New Hampshire, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation. Compcare underwrites or administers HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
CA: Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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