Health Insurance Basics
Common Health Insurance Choices
Whether you select short-term or longer-term coverage, the insurance plan you choose may include a network of doctors, specialists and hospitals (also called providers). The two most well-known types of network plans are HMOs (health maintenance organizations) and PPOs (participating provider organizations). Knowing how each type works will help you select the right health insurance for you and your family.
An HMO links you with contracting doctors and hospitals.
- A primary care physician (PCP) is the main contact for most basic care
- A PCP referral is needed for specialist visits or testing
- Need to see doctors and other providers within your HMO network to have care covered, except for emergency care
Like HMOs, PPOs often feature a network of doctors, specialists and hospitals, but there are some key differences between the two types of plans.
- Don’t have to select a PCP
- Can see in- or out-of-network doctors, hospitals and specialists
- May have to pay more for out-of-network care
CDHP and the HSA1 Option
If you choose a PPO health insurance plan, you can select a consumer directed health plan (CDHP), which pairs a high deductible insurance plan with a tax-advantaged health savings account (HSA).
Note: You must meet HSA eligibility rules, like signing up for an HSA-eligible, high deductible health plan, before creating an HSA.
- Don’t have to choose a PCP if the plan uses a PPO network
- Can visit in- or out-of-network doctors, hospitals and specialists
- May have lower monthly premiums with a high deductible health plan
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- Association of Independent Consumer Credit Counseling Agencies — This non-profit credit counseling group provides debt management and bankruptcy counseling, as well as financial education services.
- Healthcare.gov — Learn more about the Affordable Care Act and how the new law is changing health care.
- Texas Health and Human Services — Find benefits from state and local health and human services programs, like health care, food, cash and other benefits.
- Medicare — You can use this federal health care program if you’re 65 or older, or under age 65 with certain handicaps or sickness.
- Medicaid — You and your family may get free or low-cost health insurance coverage through this joint federal and state-funded program.
- Rx Assist — Find facts on programs set up by drug companies that offer the uninsured free or low-cost medication.
1 Health Savings Accounts (HSA) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.
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