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Learn about the different options available to you. 

In Wisconsin, there are five different types of private health insurance coverage to choose from, including HMO, PPO, POS, EPO and supplemental coverage. Understanding the differences in these five types of health insurance can help you identify the right health coverage for your needs. Below, we explore each of these options.

HMO (Health Maintenance Organization) Networks

An HMO is a type of health insurance coverage that usually limits members to care provided by doctors who work for or contract with the HMO.

Learn about the five different types of private health insurance coverage in Wisconsin.

Things to Consider:

  • Out-of-network care typically isn't covered unless it is provided in the case of an emergency.
  • To be eligible for coverage with an HMO in WI, you may be required to live or work within its local service area.
  • HMOs often provide integrated care and focus on prevention and wellness.
  • Members may not need a referral to see a specialist.

PPO (Preferred Provider Organization) Networks

A PPO includes a group of participating medical providers, such as hospitals and doctors, within a network.

Things to Consider: 

  • Out-of-network care is covered, but you pay less if you use providers that belong to the plan's network.
  • These plans generally cover a larger geographic area that may include providers outside of the Wisconsin area.
  • You can see specialists and out-of-network providers without needing a referral. 

POS (Point of Service) Plans

POS plans encourage you to use doctors, hospitals and other health care providers that belong to the plan’s network.

Things to Consider: 

  • You are required to get a referral from your primary care doctor in order to see a specialist.
  • You have a choice as to whether you access health care services within or outside the network of providers. 

EPO (Exclusive Provider Organization) Networks

EPOs are similar to HMOs but they generally have a smaller network of providers, which can result in premium cost savings. Members may not need a referral to see a specialist.

Things to Consider: 

  • EPOs may not require you to have a Primary Care Physician (PCP).
  • Most EPOs have no out-of-network benefits, so it’s very important to know what providers are in your network (except for emergency care).
  • Out-of-network spending does not count towards your out-of-pocket maximum. 

Supplemental Health Insurance 

This type of coverage helps pay for costs that aren’t covered by your primary health insurance plan.

Things to Consider: 

  • Health insurance supplements are not just for seniors on Medicare. They can also be purchased by individuals or families looking for additional health coverage.
  • These plans don’t meet the ACA requirement for minimum essential coverage and should be combined with another plan.
  • Supplemental insurance can be used to cover vision, dental and other specific coverage not included in most major medical plans. For example, some supplemental health plans will pay you a lump-sum if you’re admitted to the hospital. 
Now that you know about the different types of health insurance coverage, are you ready to start shopping? Quartz offers a variety of health plans for individuals, families and groups in WI. Find the right health plan for you today.