Understanding your health plan options
- Ramsey P. Welch
- October 7, 2024
As open enrollment approaches, you may have options for your health plan coverage. Your exact choices will depend on how you are eligible for coverage and what is offered.
Health plans through your employer
If you are enrolling through an employer, your human resources department should be able to inform you of your options. A Summary of Benefits and Coverage (SBC) is available to anyone looking to enroll in a health plan. It outlines the details and costs associated with care and prescriptions under a specific plan.
Health plans for individuals and families
If you do not have health plan options through an employer, you can still get coverage through the federal Health Insurance Marketplace or purchase it directly from an insurer. Visit one of our ArkansasBlue Welcome Centers for assistance in finding the right health plan.
How do you choose?
Your health history and expenses can help you choose the right type of health plan. Suppose you or a family member on your plan has a chronic condition that requires frequent appointments and medications. In that case, a plan with a higher monthly premium but lower deductible and coinsurance amounts may be best to keep out-of-pocket costs lower. If you only see a provider for yearly checkups, a plan with a lower monthly premium but higher deductibles might save you money monthly but still provide care should a need arise.
The main types of health plans are:
Health maintenance organization (HMO)
With this plan, you choose a primary care provider (PCP) who coordinates your care using doctors and hospitals in your plan’s network. If you need a specialist, such as a cardiologist, a referral from your PCP is required. Generally, an HMO won’t cover services from an out-of-network provider.
An HMO plan usually has a lower monthly premium and deductible but includes coinsurance and copays.
Preferred provider organization (PPO)
This plan allows you to manage your own care, with or without referrals from a PCP. You can choose which provider to see, although you’ll save money if you remain in-network.
A PPO usually has higher premiums than other plans but lower copays and coinsurance.
Point of service (POS)
A POS combines HMO and PPO plans. Like an HMO, you choose a PCP, who may have to refer you to
a specialist. But like a PPO, you can get medical care from in- and out-of-network providers. You’ll pay less when you use a doctor or hospital.
A POS plan may require you to pay a higher premium and have copays, but most have no deductible for in-network services referred by your PCP.
High-deductible health plan (HDHP)
This plan gives you the most control over how your healthcare dollars are spent. An HDHP usually has a higher deductible but a lower monthly premium. A Health Savings Account (HSA) is typically paired with an HDHP to help you save money for healthcare expenses.
Most HDHPs pay for several preventive care services, but you will pay out-of-pocket for additional care and prescriptions. Putting some of the money you are saving monthly on the lower premium into your HSA is a great way to offset the out-of-pocket expenses that may come up.
To learn more about the basics of health insurance, visit arkbluecross.com/healthbasics. You can also visit the Arkansas Blue Cross and Blue Shield website to learn more about your health plan and benefits.
* Details of plan types may vary by insurance provider and plan design. Please review your Summary of Benefits and Coverage (SBC) or call the number on the back of your member ID card for information about your specific plan.