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A Guide to Health Insurance for You and Your Family

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Individual Insurance

What you need to know to
help you choose

The three most common types of health plans are Health Maintenance Organizations (HMOs), Preferred Provider Organization insurance plans (PPOs) and Consumer Directed Health Plans (CDHPs). Learn more about health coverage and individual products.


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Insurance Basics

Understanding Health Coverage

Buying individual health insurance is a big decision. And big decisions require information, choices, and someone to turn to when you have questions.

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Frequently Asked Questions

Obtaining Health Coverage

Many people get health coverage through their employer. This is called group coverage. Employers may offer several plans to choose from, and employees get a chance to change their plan once a year during open enrollment.

Some people purchase their own coverage because it is not available through their employer. This is called individual health insurance coverage. Individual health insurance coverage is a good option for people who are:

  • In between jobs
  • Self-employed
  • Early retirees
  • Recent college graduates
  • Part-time workers

Some Americans receive health coverage through government programs. Some examples of government health programs are Medicare, Medicaid and other programs run by individual states.

Types of Health Coverage

Health insurance plans come in all shapes and sizes. That's why it's important to assess your needs before you choose an insurance plan. First, we can help you determine what kind of coverage you need, for example, a major medical insurance plan or a temporary insurance plan. A major medical insurance plan usually renews on a yearly basis and does not expire until you decide to terminate the policy or discontinue paying premiums. On a temporary insurance plan, you can decide if you want coverage from one to six months at a time, for a maximum of 12 months.

Major medical insurance plans usually offer an optional dental plan. The dental plan is only offered along with the health insurance plan. It cannot be purchased alone. Additional services that could be included with a health insurance plan are preventive care, prescription drug coverage and vision coverage. It is important to do research so you can find the insurance plan that provides the best coverage and services for you

Types of Products
  1. HMOs

    HMOs, available through participating employers, are a type of health plan that gives you access to certain doctors and hospitals, often called network or contracting doctors and hospitals (sometimes called "providers").

    HMO Basics:

    When you sign up, you select a primary care physician (PCP) from a network of doctors.

    Your PCP is your first point of contact for most of your basic health care needs.

    Women can also select an OB/GYN for obstetrical and gynecological care.

    If you need special tests or need to see a specialist, your PCP will give you a referral to see another doctor.

    Learn more from Blue Cross Blue Shield:
    HMO Rights and Responsibilities

    The Bottom Line:

    HMO plans generally have lower up-front costs, or premiums, than other types of plans.

    HMOs usually feature copayments as well. Copayments are set amounts (usually a dollar amount or a percentage) that you pay for care. An example of a copayment is $20 for each office visit.

    HMO plans generally provide coverage only when you use doctors, hospitals and specialists that are in the network.

    If you seek care outside the network, other than in an emergency or with authorization from your HMO, your care typically will not be covered at all.

  2. PPOs

    Like HMOs, PPOs often feature a network of doctors, specialists and hospitals; however, there are some key differences between the two types of plans.

    PPO Basics:

    With a PPO insurance plan, you don't have to choose a primary care physician.

    You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

    Key Features:

    PPO insurance plan premiums are generally higher than HMO plans, which means you'll have to pay more up front.

    When you receive care from a doctor or hospital that is in the network, your costs tend to be lower.

    When you receive care from a doctor or hospital outside the network your costs are likely to be higher, and you may be responsible for the difference between the amount your insurance plan pays and the provider's billed charges.

    PPO insurance plans usually have a deductible. So, for example, if your PPO insurance plan has a $500 deductible, your coverage doesn't begin until you've paid out-of-pocket for the first $500 of your own medical expenses. Preventive care services are not subject to the deductible

  3. CDHPs and the HSA Option

    Consumer Driven Health Plans (CDHPs) often involve pairing a high deductible PPO insurance plan with a tax-advantaged account, such as a Health Savings Account (HSA)1. For an individual to establish an HSA and contribute money to the account each year, he or she must be considered an HSA-eligible individual. Eligibility includes enrollment in an HSA-qualified high deductible health insurance plan. Learn more from Blue Cross Blue Shield -

    Guidance on choosing a health insurance plan:
    U.S. Agency for Healthcare Research and Quality (AHRQ)

    Key Features:

    If the insurance plan uses a PPO network, you don't have to choose a primary care physician

    You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

    The Bottom Line:

    When a CDHP includes a high deductible health insurance plan, premiums are often lower than other types of health plans because you are responsible for a greater share of your health care costs.

    If the health insurance plan is an HSA-qualified high deductible health insurance plan, and you are an HSA-eligible individual, you may establish an HSA and make contributions to the account each year.

    An HSA is a savings account that you can use to cover a wide range of qualified medical expenses. HSAs have special tax advantages and are regulated by the Treasury Department.


Health Savings Accounts (HSA)1 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


Consult these resources for more information about individual health insurance plans:
National Health Law Program:
Tips on getting health insurance you need

HSA Limits

Health Savings Account

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