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Individual
ICHRA
Marketplace
Dental
Vision
Medicare Supplement
Note: Not Available in All States.
Having the right health insurance coverage provides peace of mind, knowing you and your family are protected against the unpredictable nature of health concerns and medical costs. Here are a few coverages to consider:
Health Maintenance Organization (HMO): Typically requires you to choose a primary care physician (PCP) within the plan's network and get a referral from your PCP to see other specialists. Out-of-network care is generally not covered, except in emergencies.
Preferred Provider Organization (PPO): Gives you the flexibility to see any doctor or specialist, both in and out of the network, without a referral. However, you pay less for services from in-network providers.
Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network, except in emergencies. Like an HMO, you don't need a referral to see a specialist, but unlike a PPO, you have no out-of-network coverage.
Point of Service (POS): A hybrid of an HMO and PPO. You may be required to choose a PCP, but you can go out-of-network for care, though you will pay more.
Individual Coverage Health Reimbursement Arrangement (ICHRA): ICHRA plans are a modern alternative to traditional group health insurance. Instead of offering one specific plan, an employer gives employees a tax-free allowance to use for their own individual health insurance premiums and other qualified medical expenses. The employee then purchases a plan that best fits their personal needs and budget, either through the Health Insurance Marketplace or directly from an insurance company. This gives employees more choice and flexibility, while allowing employers of any size to control their healthcare budget and offer a competitive benefit.
Catastrophic Plans: These plans have very low monthly premiums but a high deductible. They are designed to protect you from financial ruin in the event of a major, unexpected medical event, such as a serious illness or accident. They are typically available only to people under age 30 or those with a hardship exemption.
Dental Insurance: This provides coverage for dental care, including routine cleanings, X-rays, fillings, and more complex procedures like crowns or root canals. It can be a standalone policy or a rider on your primary health plan.
Vision Insurance: Provides coverage for vision care, including routine eye exams, prescription glasses, and contact lenses. This can also be a standalone policy or an add-on to your health plan.
Short-Term Health Insurance: Designed to provide temporary coverage for a limited period, typically when you are between jobs, waiting for new coverage to start, or outside of the open enrollment period. These plans do not have to comply with the Affordable Care Act (ACA) and often do not cover pre-existing conditions or essential health benefits.
Supplemental Health Insurance: These policies provide a lump-sum cash benefit directly to you for a specific event, such as a critical illness (e.g., cancer or heart attack) or an accident. The money can be used to pay for medical expenses, deductibles, or non-medical costs like rent or groceries.
Medicaid: A joint federal and state program that provides low-cost or no-cost health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Eligibility rules vary by state.
Medicare: The federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It is divided into several parts:
Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Part C (Medicare Advantage): A type of Medicare health plan offered by a private company that contracts with Medicare. It includes Part A and Part B benefits and often includes Part D (prescription drug) coverage.
Part D (Prescription Drug Coverage): Adds prescription drug coverage to Original Medicare.
Medicare Supplement (Medigap): This is an optional private insurance policy you can purchase to help pay for some of the out-of-pocket costs that Original Medicare (Parts A and B) doesn't cover. These can include copayments, coinsurance, and deductibles. Medicare Supplement plans work alongside your Original Medicare and are standardized by a letter (e.g., Plan G or Plan N), which means the benefits for a particular lettered plan are the same no matter which insurance company sells it. You cannot have both a Medicare Supplement plan and a Medicare Advantage Plan at the same time.
Note: This list in not comprehensive and does not provide official insurance policy language. Coverage options may differ among insurance companies and policy types. Availability varies by State.