Learn the Difference Between Family Health Insurance Plans

Having a health insurance plan that fits your personal and family situation is essential. Since it is a preventive tool, it’s preferable to invest in a plan that will keep you protected even if you don’t use it.  You don't want to reach the point when you really need it and find out that you don’t have sufficient protection.

For this reason, it’s very important to choose the health insurance plan that best suits you and your family, especially if your job does not offer group health insurance, or if the one offered is very limited.

Why are there different types of health insurance plans?

There are different types of health insurance plans to cover different contexts and lifestyles. Some of the different characteristics that you should consider while choosing a plan are: risk factors, hereditary diseases, lifestyle, occupational risks, among others. Depending on these factors, you’ll come across a variety of coverages and specific characteristics for each plan.

Main types of health insurance plans in the United States

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In the United States, there are four main types of insurance that you should know about:

Health Maintenance Organization (HMO) health insurance plans

These insurance plans are based on companies that offer a network of private services that include both medical personnel and hospitals.

Keep in mind: The costs for these plans are generally affordable and they offer both preventive and corrective care. The caveat is that you’ll need to live in an area where these services are available in order to be insured.

More information about HMOs

Preferred Provider Organizations (PPO) health insurance plans

This is a network of health professionals and hospitals that offer discounts for their insured; you can choose the services that best suit your requirements.

Keep in mind: If for any reason you need care from an unaffiliated specialist, there is an option to pay an extra fee to be treated by them without the need for a prior evaluation.

More information about PPOs

Point Of Service (POS) health insurance plans

This is a network of services and providers in which the insured needs an evaluation by a general practitioner before a specialist is seen.

Keep in mind: You’ll still be allowed you to choose doctors and other external services, but at a higher cost.

More information about POSs

Exclusive Provider Organization (EPO) health insurance plans

This type of insurance provides medical and hospital care within an available network of services.

Keep in mind: It is the strictest type of plan and you will not be able to keep seeing your family doctor if they are not affiliated with the network. Consider this beforehand if it is particularly important for you to keep visiting your current doctor.

More information about EPOs

When the time to select your health insurance plan comes, we recommend that you do not just choose the first option that you find. It is advisable to review as many options available to you as possible. Also consider that providers offer a variety of options that are classified depending on the percentage of the healthcare costs covered by their plans. These classifications are: Platinum, Gold, Silver and Bronze.

Special health insurance plans

The government offers special programs focused primarily on vulnerable groups with limited resources.

Government insurance plans are geared to:

  • Seniors over 65 years of age
  • Anyone who does not have or cannot afford health insurance
  • Children up to 19 years of age whose families have a yearly income of up to $44,700
  • Pregnant women

How to get help if your rights are violated

If you feel that your rights are being violated or that your insurance is not complying with the agreed-upon contract, you can contact the National Association of Insurance Commissioners in your state. We also recommend that you look into the consumer protection services offered by the government. 

Tips for selecting a family health insurance plan

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Carefully compare before buying

Policies vary in coverage and cost. We recommend that you make a chart to compare the most relevant characteristics of the different options that you have. This is usually the best strategy to select the plan that meets your needs and expectations.

Get coverage for major medical expenses

Make sure your insurance policy protects you from major medical expenses. We are aware that reading the small print of an insurance policy is not your idea of a fun Saturday night, but if you overlook them you will be uninformed on your and your loved ones' health.

Carefully review your policy and write down anything that you find confusing. Ask both an insurance advisor and the company that provides the policy to clarify these aspects.

Have a way out

Verify that the contract has a reconsideration clause. Most companies give you at least 10 days to examine your policy after you receive it. If you decide that the new plan you just selected is not right for you, you can cancel it and receive a full refund.

Pay attention to all the details

Be careful with policies that cover a single illness. There are some health insurance plans that offer protection only for one condition such as cancer.

The most important rule of insurance selection is: make sure you are very clear on what you are buying and what you are leaving on the table. Make sure that you have reviewed all the relevant information before you take any action.