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.