Comprehensive Health Plans - Minimum Essential Coverage
It is important to know the different types of health plans to make the best use of your benefits and money.
In order to satisfy the requirement for having health insurance under the Affordable Care Act, your plan must provide minimum essential coverage (MEC). MEC may be an individual or group health plan, Medicaid, the Healthy Michigan Plan, and Medicare. The most common major medical plans providing MEC are described below.
For more information related to MEC health plans, visit www.healthcare.gov.
- Health Maintenance Organization (HMO)
An HMO is a type of health plan that usually limits coverage to their network of providers. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in the service area to be eligible for coverage. All care is coordinated through the member’s primary care physician (PCP); therefore, you must designate a PCP.
- HMO Point-of-Service Plan
An HMO Point-of-Service plan offers in-network and out-of-network benefits. There may be higher out-of-pocket costs for health care services received outside of the HMO’s network.
- Preferred Provider Organization (PPO)
A PPO is a contract between an insurer and a network of providers agreeing to provide health care services at a negotiated rate. PPOs may be less restrictive than HMOs because they do not require a referral to see other providers. There are also out-of-network benefits with a higher financial responsibility.
- Preferred Provider Arrangement (PPA)
A PPA is an optional feature of a health plan. The plan includes a network of participating providers available to the insured to obtain cost-effective medical services.
- High Deductible Plans
These major medical plans are often sold in conjunction with Health Savings Accounts. They pay the cost of inpatient hospital care and outpatient medical bills with high deductibles. The financial responsibility under these plans changes annually and is paid from a federally tax-exempt Health Savings Account.
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