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.
