Private & Employer Insurance
This type of plan is owned by the individual and is not offered through an employer or as part of a government-sponsored program. There are two major types of private plans available in the United States: managed health care and indemnity health.
- Managed Health Care Plans
- Managed health care plans are tailored to give the insured the best quality coverage at an affordable cost. There are three types of managed health care plans including HMOs (Health Maintenance Organization), PPOs (Preferred Provider Organization) and POSs (Point of Service). These plans utilize a network of doctors who perform medical services at a contracted rate. A dedicated PCP (Primary Care Physician), a doctor who coordinates a member's medical care, may be required or may be highly recommended under some plans. A member pays low out-of-pocket expenses and receives higher benefit amounts if they stay within the network for care and/or receive a referral from their PCP for any visit to a specialist.
- Indemnity Health Plans
- Indemnity health plans allow the insured to seek medical attention regardless of location or cost. There are three options under this type of plan. One pays the insured 100% of the total claim, and another pays a percentage, usually 80%, while the insured pays the rest. The third option pays the insured a set amount each day for services for a maximum number of days. Indemnity health plans, although the most flexible, are also the most expensive of all private plans.
Employer Group Health Plans (EGHP)
Your insurance may come from a job that you or a family member have now, used to have, or retired from. These plans can have a lot of names, and may not actually say EGHP, but if it is health insurance that began through an employer, it is probably an Employer Group Health Plan (EGHP).
If you have an EGHP, it’s important to keep it for the following reasons:
- Your EGHP may cover routine physicals, medications, shots, surgery, eye exams and glasses or contacts, dental exams and dental work, hearing exams and hearing aids. These may not all be covered by non-group plans or by Medicare.
- EGHPs may have lower premiums than non-group plans.
- EGHPs may get money-saving discounts from healthcare providers that non-group plans don’t get.
It is important to maintain your EGHP for as long as possible. If you drop your coverage for any reason, you may have fewer options for obtaining new insurance because of kidney failure.
Speak to the plan administrator through your employer’s Human Resources department to find out how your plan works.