Skip to content 
Choosing a health plan is one of the most important decisions you will make. It determines which doctors you can see, how much you pay for your health care, and your options for treatment. If you aren’t happy with your original choice, you may have to wait a year before you can change to a different one.
Getting the right health insurance isn’t something you should learn by trial and error. Before you make a decision that might not meet your needs, consider the following health plan tips by GTCIPA.
1. Understand the 4 Levels of Coverage
The four levels of health insurance plans are named after four metals: bronze, silver, gold, and platinum. Each of these metals increases in value, with bronze being the least and platinum the greatest.
When used to describe categories of health insurance, the levels define how much of your health care the insurance pays and your share of the cost. For the Bronze level, the insurance company pays 60% of your care, while you pay the remaining 40%. With each increasing level, the insurance company pays an additional 10% and you pay 10% less. So, with a Silver healthcare plan, the insurance company pays 70% of your healthcare costs while you pay 30%.
2. Learn Your Total Costs for Health Care
The premium is the amount that you pay each month for your health care plan. You must pay the premium even if you don’t use your insurance. You also pay out-of-pocket costs including the deductible every time you see a doctor or get a prescription filled. In addition, you must pay for all medical care that isn’t covered under your plan.
There are different costs associated with the various health plans accepted by Greater Tri-Cities. When choosing a plan, make sure you consider the total costs and not just the price of the premium.
3. Learn the Difference Between Plan and Network Types
People often sign up for a health care plan only to find out that they can’t see their regular doctor or that they must pay more to go to the doctor of their choice. You could end up losing options that are important to you if you don’t understand the differences in plans and networks. The four basic types include HMO, PPO, POS, and EPO.
- HMO – A health maintenance organization usually limits care to doctors contracted with the organization’s group. The only exception is when you require emergency care.
- PPO – A preferred provider organization contracts with doctors and hospitals to create a network of healthcare providers. You have the option to use providers and facilities outside of the network, but it costs you more.
- POS – Some POS or point-of-service plans offer a lot more flexibility. They allow you to use the doctors or health care facilities of your choice. Other POS plans are more restrictive about letting you choose, or they charge you more for going out of network.
- EPO – An exclusive provider organization plan only pays providers or hospitals in their network. The only exception is for emergencies.
Our accepted GTCIPA health plans include those like Alignment, which is an HMO, POS, and PPO plan. We also carry numerous HMO and POS plans to provide you with quality, affordable health care.
Better Access to Quality Health Care
Getting the right health insurance doesn’t have to be complicated. The more you understand the different types of health care plans, the easier it is to find the best one for you. Start by comparing the health plans accepted by greater tri-cities. Next, choose your new physician or specialist. If you need more information, contact the GTCIPA team.
Our Primary Care Physicians at Greater Tri Cities IPA
