Wk 2 Discussion - Insurance Coverage

Get Answers

Español Log in

Get Coverage Keep or Update Your Plan See Topics SEARCH

How to pick a health insurance plan EMAIL✉ PRINT

Health insurance plan & network types: HMOs, PPOs, and more 3 things to know before you pick

a health insurance plan

The 'metal' categories: Bronze,

Silver, Gold & Platinum

Catastrophic health plans

Health insurance plan & network

types: HMOs, PPOs, and more

Your total costs for health care:

Premium, deductible & out-of-

pocket costs

There are different types of Marketplace health insurance plans designed to meet different

needs. Some types of plans restrict your provider choices or encourage you to get care

from the plan’s network of doctors, hospitals, pharmacies, and other medical service

providers. Others pay a greater share of costs for providers outside the plan’s network.

Types of Marketplace plans

Depending on how many plans are offered in your area, you may find plans of all or any of

these types at each metal level – Bronze, Silver, Gold, and Platinum.

Some examples of plan types you’ll find in the Marketplace:

Exclusive Provider Organization (EPO): A managed care plan where services are

covered only if you use doctors, specialists, or hospitals in the plan’s network (except

in an emergency).

Health Maintenance Organization (HMO): A type of health insurance plan that

usually limits coverage to care from doctors who work for or contract with the HMO.

It generally won't cover out-of-network care except in an emergency. An HMO may

require you to live or work in its service area to be eligible for coverage. HMOs often

provide integrated care and focus on prevention and wellness.

Point of Service (POS): A type of plan where you pay less if you use doctors,

hospitals, and other health care providers that belong to the plan’s network. POS

plans require you to get a referral from your primary care doctor in order to see a

specialist.

Preferred Provider Organization (PPO): 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.

Get more information on what you should know about provider networks (PDF).

Need dental coverage? Visit our Dental coverage in the Marketplace page

to learn more about options available to you.

Can we improve this page?

Give feedback

RESOURCES

About the Affordable Care Act

Regulatory and Policy

Information

For Navigators, Assisters &

Partners

For Agents & Brokers

For the Media

For Researchers

For States

Information in other languages FacebookTwitterYouTube

CONNECT WITH US

 Questions? Call 1-800-318-2596

 Find Local Help

 Visit the HealthCare.gov blog

ALL TOPICS | GLOSSARY | CONTACT US | ARCHIVE NONDISCRIMINATION / ACCESSIBILITY | PRIVACY POLICY | PRIVACY SETTINGS | LINKING POLICY | USING THIS SITE | PLAIN WRITING

中⽂ | KREYÒL | FRANÇAIS | DEUTSCH | ગુજરાતી | िहंदी | ITALIANO | 日本語 | 한국어 | POLSKI | PORTUGUÊS | РУССКИЙ | ESPAÑOL | TAGALOG | TIẾNG VIỆT

HHS.gov A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244. Health Insurance Marketplace® is a registered trademark of the Department of Health and Human Services.

Whitehouse.gov USA.gov

Back to top

START HERE

Search