Marketplace health insurance plans are designed to meet different healthcare needs. Some plans restrict provider choices, while others offer greater flexibility in choosing doctors, hospitals, and specialists.
Depending on the options available in your area, you may find plans across all metal levels—Bronze, Silver, Gold, and Platinum.
Here’s a breakdown of the most common plan types:
✔ Exclusive Provider Organization (EPO)
Covers services only if you use doctors, hospitals, and specialists within the plan’s network (except in emergencies).
✔ Health Maintenance Organization (HMO)
Typically limits coverage to doctors and facilities within the network.
Out-of-network care is not covered, except in emergencies.
May require you to live or work within the service area.
Focuses on integrated care, prevention, and wellness.
✔ Point of Service (POS)
Offers lower costs when using in-network providers.
Requires a referral from your primary care doctor to see a specialist.
✔ Preferred Provider Organization (PPO)
Allows you to see both in-network and out-of-network providers.
No referral needed for specialists.
Higher costs for out-of-network care.
Each plan type has its own pros and cons, so selecting the best option depends on your healthcare needs and budget.
Need help deciding? Contact us today for free guidance in selecting the right policy for you and your family.
For more details, visit www.healthcare.gov.
This Medicare information section is here to educate you about your insurance options and provide you with the resources you need to help you select the right plan for your unique needs.
If there’s anything you need or if you have any questions, please feel free to contact us. We are here to help.