Thursday, March 23, 2023

Types of health insurances in the USA

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In these contemporary times, health issues have become more and more common. As a result, over 95% of the world’s population has health issues. So it would be worth to know what are the types of health insurances in USA that help you to create solutions for your health problems. 

Types of health insurances in the USA

Health issues occurred because of lack of sleep, lack of exercise, and bad diet habits. In addition, due to workplace stress, people tend to forget about their health. And in the long term, they will diagnose with incurable chronic diseases, but some are curable. Of course, you can avoid these, but you may be too busy with the work-life.

Even though it is avoidable and you take all the necessary precautions to prevent getting sick, you are still prone to injury. You still can be in a car accident or fall off the stairs, leading to an injury. That is when insurances come into play.

Regardless of whether you have a healthy lifestyle, getting yourself the best type of health insurance is essential. This world is filled with an endless number of possibilities, and you can never be too safe. You can never go wrong with health insurance. Let us see what are the types of health insurances in USA.  There are two main types of health insurance,

  • Private
  • Public

Further, we can break down those into seven types of health insurance plans.

  1. Preferred Provider Organization (PPO)
  2. Health Maintenance Organization (HMO)
  3. Point of Service (POS)
  4. Exclusive Provider Organization (EPO)
  5. Indemnity Health Insurance plan
  6. Health Savings Account (HSA)
  7. Health Reimbursement Arrangements (HRA)

Private Health Insurance

According to the Centers for Disease Control and Prevention (CDC), the Healthcare System of the USA is mainly reliant on private health insurance. According to the National Health Survey, 63.7 percent of adults under 65 in the United States have at least some form of private health insurance coverage. In addition, most people have private health insurance because it is more reliable. In contrast to government-run insurance programs, private health insurance refers to policies sold by private health insurance companies.

Currently, private medical insurance covers a little more than 50% of the population in the United States. Employer-sponsored plans, which cover nearly half of the American population, have a private health insurance plan. In addition, approximately 6% of Americans buy private medical insurance in the individual/family market, both in and out, outside of their job. Private health insurance comes in a plethora of ways that are less regulated than typical primary medical coverage.

Short-term health plans, fixed indemnity plans, serious illness plans, accident insurance, dental and optical insurance, and so on are all examples of this. Private health insurance firms sell all of these types of coverage. Still, they are often only acceptable as supplemental coverage rather than primary coverage or, in terms of short-term health care insurance, to make sure a person is for a concise period.

Types of health insurances in the USA

Public Health Insurance

Public Health Insurance program run by the government and it covers some or all of your healthcare costs. There are two types of public health insurances,

  1. Medicare
  2. Medicaid


This is an insurance program in the USA designed for the elderly and disabled citizens of the United States.  This program originated in the year 1965 by the title XVII of the social security act. The Medicare coverage extended by the balanced budget act of 1997, and it includes pap smears, prostate, annual mammograms, colorectal cancer screenings, osteoporosis diagnosis, and diabetes management.

This public health insurance subsidized in exchange for a premium. Medicare, the veterans’ health administration, and the Indian health service are few public health insurance providers in the United States of America.

This service is eligible for individuals, including their spouses, who have paid into the social security system for about ten years. They will qualify for Medicare if they are 65 years and older or disabled and eligible for social security benefits or have permanent kidney failure requiring a transplant or dialysis.

Preferred Provider Organization (PPO)

This is the most common plan among people because you can select any doctor of your choice and healthcare facility you like, which is within the means of your insurance company. Employees covered by a PPO plan must seek medical care from doctors or hospitals on their insurance company’s preferred provider list in order for claims to be reimbursed at the maximum level.

This is also best for you if you want the option to have external network costs covered. You will be able to be consulted by a specialist without being referred by a primary care physician. But there are a few known disadvantages to this as well. Not everything is perfect, nor is any service given to you without any downside to it. You will usually have to pay a larger amount monthly. You will also have to pay an amount out of your pocket before the insurance covers anything for you.

Health Maintenance Organization (HMO)

A Health Maintenance Organization (HMO) is a sort of a group health insurance plan. Employees with an HMO plan have a reduced out-of-pocket expense but less flexibility in choosing physicians or hospitals than those with other plans. Employees may be required by an HMO to select a primary care provider (PCP). To see a specialist, employees will require a referral from their primary care physician. HMOs, on the whole, cover a more comprehensive range of preventative care than other types of insurance. People who work may or may not be required to pay a deductible amount before coverage begins, and they will almost certainly be required to produce a co-payment. So HMO is a good option for you, if you want to lower premium rates, as the trade-off of in-network services, like preventative measures like immunization and checkups.

Point of Service (POS) Health Insurance Plans

A POS policy is a group health insurance coverage that is sold at a point of service. HMO and PPO elements combined in POS plans. Employees in POS plans, similar to those in HMOs, may force to choose a Primary Care Physician (PCP) from the plan’s provider network. In most cases, the PCP’s services are not subject to the policy’s deductible. Employees may be eligible for a higher level of coverage if they use covered services given or referred by their PCP. They may be liable to a deductible and a lower level of coverage if they get assistance from a non-network provider. They may also be required to pay in advance and submit a reimbursement claim.

Exclusive Provider Organization (EPOs) Health Insurance Plans

A group health insurance policy known as an Exclusive Provider Organization (EPO) is a type of group health insurance. EPO plans are similar to HMO plans in that they have a network of doctors that members must use unless there is an emergency. Employees will have a primary care physician (PCP) who will recommend them to specialists in the network. Small co-payments require EPO members, and a deductible.

Indemnity Health Insurance Plans

Do you know that fee-for-service plans predetermined quantities or percentages of costs paid to the member to cover treatments, indemnity health plans. Deductibles and co-insurance costs may be the member’s responsibility. Most of the time, the member will pay out of pocket first and then submit a claim to be reimbursed for the amount that was covered by the plan.

Health Savings Account (HSA) Health Insurance Plans

An HSA is a type of health savings account that can use instead of typical group health insurance. A Health Savings Account (HSA) is a type of health savings account. A Health savings account is tax-dominant savings account that can use to pay for qualifying medical expenses when combined with a high-deductible health plan that is HSA-compatible. Even though HSAs can link to group health insurance, employees hold them, and small firms can contribute to them regardless of whether they offer a group policy. Contributions to an HSA can make before taxes, up to specified IRS limits. Each year, unused money in an HSA account rolls over and earns interest, which is tax-free. So you can compensate other life events with the funds, although there may be penalties and interest to pay.

Health Reimbursement Arrangements (HRAs)

A health reimbursement agreement is a sort of health benefit that allows employers to give health benefits without providing a group health insurance plan to their employees. Instead, employers reimburse employees for premiums and even out-of-pocket medical expenses through an HRA. Employers can set a monthly allowance cap for employees to utilize with each HRA. So you as employee can look for the most acceptable individual health insurance policy for your needs and submit proof for the purchase.  There are six different varieties of HRAs, each with its unique set of functions and needs –

  1. Qualified Small Employer HRA (QSEHRA)
  2. Individual coverage HRA (ICHRA)
  3. Group coverage HRA
  4. Excepted benefit HRA
  5. Dental/Vision HRA
  6. Retiree HRA

So, in conclusion, Health insurance plays a significant role in our lives. It ensures that if we face any health issue, it will cover for us, and we will not have to worry about not being able to pay off a hefty bill after treatment. Before you decide which insurance plan given by a specific company is right for you, you must make sure that the insurance company you choose will benefit you.

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