Explore health insurance

Preferred provider organization (PPO), high-deductible (HDHP), and health maintenance organization (HMO) health plans differ in terms of provider networks, out-of-network coverage, and out-of-pocket costs vs. monthly premiums. They're the three most common types of health insurance plans.

PPO: The most common type of health insurance plan. PPOs cover about half of Americans with employer-sponsored health insurance. PPOs usually have higher premiums, but with lower out-of-pocket costs when you need health care services. PPOs also offer more flexibility. Members can see in-network and out-of-network doctors. However, you’ll likely have to pay more to see an out-of-network provider.

HDHP: As the name suggests, HDHPs have high deductibles. They usually have cheaper premiums, but you’ll pay more out-of-pocket when you need health care services. Slightly less than one-third of Americans in an employer-sponsored plan have a HDHP.

HMO: HMOs have lower premiums then PPOs and fewer out-of-pocket costs than HDHPs. HMOs have restricted provider networks. That means you’ll probably only be able to see in-network providers. If you get care outside of your network, you may have to pay for all the services without any help from the insurer. HMOs also require a referral from a primary care provider if a patient needs to see a specialist.

When choosing a health plan, consider the monthly cost of premiums and the out-of-pocket costs when you need care, including the deductible and copays, the provider network, and the likelihood of needing expensive care based on your health history. Consider:

• Premiums
• Out-of-pocket costs
• Deductible
• Provider network
• Plan type
• Your income
• Your medical history
• You and your family’s upcoming health care needs

All of these issues play into which health plan is best for you.

Out-of-network providers and facilities don’t have in-network contracts with your insurer. Some health insurance plans, usually PPOs, cover out-of-network care, but with higher out-of-pocket costs to you. Other plans, usually HMOs, do not cover out-of-network care at all. Check your network coverage before seeing any new provider.

The open enrollment period for those who get health insurance through an Affordable Care Act (ACA) plan runs from Nov. 1 to Jan. 15, but a handful of states have different open enrollment periods. If you get coverage through an employer, the business will decide on its open enrollment period. Medicare’s open enrollment is Oct. 15-Dec. 7. There is no open enrollment period for Medicaid.

COBRA allows you to keep your employer-sponsored health plan if lose your job. Your employer will no longer pay any portion of your premiums, leaving you responsible for the full amount. This option allows you to maintain coverage, but is very costly.

A short-term health plan offers low-cost coverage for a short period of time, usually one year, but does not provide the same protections as regular health insurance. You may pay hefty out-of-pocket costs and have limited provider choices with a short-term plan. Short-term plans also offer fewer consumer and patient protections than ACA plans.

Yes. Some people qualify for both Medicare and Medicaid if they meet the requirements for both. This is known as being dual eligible. If you have both, Medicare is your primary coverage, and Medicaid is secondary, covering remaining costs.

Medicare includes original Medicare, which is Parts A and B. This coverage is for care done by hospitals and physicians. Medicare Part C, also called Medicare Advantage, is offered through a private insurance company. Part D is prescription drug coverage. Medicare Advantage usually has dual prescription drug coverage, so you only need Part C. However, people with Parts A and B may want Part D coverage to help them with prescription drugs.