Types of Health Insurance

  1. Major Medical Insurance
  2. Limited Benefit Plans
  3. Additional Coverage Options
  4. Plans that are Not Health Insurance
This type of policy is usually effective in covering serious illness or injury where costs are high. Hospital care, drugs, and doctors’ visits are usually covered.

Under the Affordable Care Act, most of these plans cover the 10 categories of Essential Health Benefits:
  1. ambulatory patient services (outpatient care you get without being admitted to a hospital)
  2. Emergency services
  3. Hospitalization (like surgery and overnight stays)
  4. Pregnancy, maternity, and newborn care (before and after birth)
  5. Mental health and substance use disorder services, including behavioral treatment (like counseling and psychotherapy)
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management 
  10. Pediatric services, including oral and vision care (but adult dental and vision coverage isn't required)

These benefits can be delivered in several different ways:
  • Exclusive Provider Organization (EPO) Plans: This is a type pf managed care plan where services are typically only covered if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).
  • Preferred Provider Organization (PPO) Plans: In these major medical plans, the insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to seek care from a doctor or hospital that is not a preferred provider, but you will probably have to pay a higher deductible or co-payment.
  • Health Maintenance Organization (HMO) Plans: These major medical plans usually make you choose a primary care physician (PCP) from a list of network providers. Your PCP is responsible for managing all of your health care. If you need care from any network provider other than your PCP, you may have to get a referral from your PCP to see that provider. You must receive care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is usually not covered (except in an emergency).
  • Point of Service (POS) Plans: A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.