You have to start somewhere. Let's break down the essentials of getting yourself insured.
The Affordable Care Act (ACA) — sometimes called Obamacare — is the health care reform law that makes health plans available to people who are looking to buy their own health plan.
If you don’t have, or lose, coverage through your employer, you have a few different options for staying insured.
Quality, affordable individual and family plans that cover preexisting conditions, the 10 Essential Health Benefits, and more.
Health coverage for uninsured children and teens under age 19. CHIP plans can be low-cost or free depending on household income.
COBRA is a federal program that allows you to extend employer benefits for a limited time after you lose your job.
What are the main differences between these types of provider networks?
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PPO
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EPO
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HMO
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|---|---|---|---|
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PCP Required
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No
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No
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Yes
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Out-of-Network Coverage
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Out-of-network coverage typically costs more than in-network coverage, but emergency and urgent care are always covered at in-network rates. Highmark Individual and Family Plans cover routine care from out-of-network providers at two different levels: Routine care from an out-of-network provider in Pennsylvania may cost more than seeing an in-network provider. Routine care from an out-of-network provider outside of Pennsylvania may cost more than seeing an out-of-network provider in Pennsylvania. |
For medical emergency and urgent care only.
Emergency and urgent care are always covered at in-network rates. |
For medical emergency and urgent care only.
Emergency and urgent care are always covered at in-network rates. |
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Referrals needed
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No
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No
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Not Always
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|
|
PPO
|
EPO
|
HMO
|
|---|---|---|---|
|
PCP Required
|
No
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No
|
Yes
|
|
Out-of-Network Coverage
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Yes, at a higher cost
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For medical emergencies only
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For medical emergencies only
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Referrals needed
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No
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No
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Often, not always
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* Only a requirement for purchasing plans on the marketplace. There is no citizenship requirement for purchasing plans directly though Highmark or other health insurance companies.
You can purchase individual or family ACA plans via:
If you're confused by health insurance terms, you're not alone. There are five common terms you need to know.
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