Selecting a Health Care Plan

2) There are different TYPES of health insurance plans and each is designed to meet different needs. Some types restrict the providers you can see or where you can go to get care, while others pay a greater share of costs for providers outside the plan’s network:

• Health Maintenance Organization (HMO) - 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.
• Preferred Provider Organization (PPO) - 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.
• Point of Service (POS) - 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.
• Exclusive Provider Organization (EPO) - services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

3) Catastrophic health insurance plans are only available to people under the age of 30 or people of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable). If you are eligible for a Catastrophic plan, you will see them displayed when you compare plans in the Marketplace.

Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from serious health conditions or injuries, but you pay for most of the routine medical expenses yourself. Catastrophic plans cover essential health benefits, certain preventive services at no cost and at least 3 primary care visits per year without meeting the deductible; however, the insurance company will not pay for all covered services until you meet your deductible. In 2020, the deductible was $8,150.