Health Insurance for the Whole Family
Key Takeaways
- You should know and understand your insurance options to avoid unnecessary medical expenses.
- There are two plan arrangements your family should consider before purchasing insurance: an individual plan for each family member or a single-family plan for all family members.
- Multiple individual plans are a good option if your family has different healthcare needs, while a family plan is a good fit if you all have similar health needs.
- After deciding on a plan arrangement, it’s time to decide which managed care plan is the best fit for your family: PPO, POS, or HMO.
- PPO plans provide flexible coverage with both in-networkIn-network refers to the doctors, hospitals and other providers that are inside of your provider network. A provider network is a group of providers that have agreed with your health insurance company to treat its customers. and out-of-networkOut-of-network refers to doctors, hospitals and other providers that do not have an agreement to treat your health insurance company’s clients. Visiting an out-of-network provider typically means more out-of-pocket costs and less coverage. coverage. HMO plans offer no coverage for out-of-network services and POS plans combine elements of both PPOs and HMO plans.
Understanding the Difference: Individual Coverage vs. Family Coverage
The hardest part about getting health insurance coverage is finding the right plan — especially for families. There’s a lot to think about when it comes to making sure your whole family has health insurance coverage. It helps to understand how health insurance works to choose the best coverage arrangement for your family.
For complete family health insurance, you have two basic coverage options.
Individual plans for each family member
This is the best insurance option for families whose members have different health needs. If a member has a chronic illness such as diabetes or asthma, individual plans could be the most cost-effective way to go. With individual plans, family members who don’t need frequent medical care are on separate plans and can avoid paying for coverage that they won’t use or need.
Cover everyone with your individual plan
Some insurance companies will allow you to add family members under your individual coverage, making it a “family plan.” If your family needs coverage for routine and emergency care, this is a good option to consider. One individual family health insurance plan is most affordable if everyone has similar health needs.
Still have questions? GoHealth has the answers you need.
Choosing Your Type of Plan(s)
Decide whether multiple individual plans or a single family plan is right for your family. Next, which type of plan is best for your needs.
Managed care plans are popular choices for affordable family health insurance, no matter which coverage arrangement you choose. They create networks of doctors, hospitals, clinics, specialists, and other healthcare professionals — all who provide their medical services at discounted rates. For you and your family, that means lower health plan costs — including more affordable premiums, copayments, and coinsurance.
What are the most common kinds of managed care plans?
- PPOs (Preferred Provider Organization). The PPO plan provides flexible coverage. You and your family will save money when going to a preferred in-network physician, but you’ll also have coverage with out-of-network doctors. For comprehensive, flexible, and affordable coverage, the PPO is a popular choice[i] for family health insurance.
- HMOs (Health Maintenance Organization). The HMO is one of the most affordable kinds of managed care — and another common family health insurance choice. Copayments can be as low as $10, and many HMOs don’t require a deductible. You choose a primary care physician from your HMO network, and they’ll be the first doctor you go to for care. If you or a family member needs specialist care, your primary care physician will need to give you a referral. The only downside to HMO plans is that services are not covered outside the HMO network.
- POS (Point Of Service) Plans. The POS plan combines elements of an HMO and PPO together. Like an HMO, you’ll choose a primary care physician from the preferred network as your “first line of defense” doctor. Like a PPO, you’ll have coverage with any healthcare provider — inside or outside of the network.
FAQs
Are there other options besides HMOs, PPOs and POS plans?
Exclusive Provider Organization (EPO): EPOs are managed care plans that require you to see ONLY in-network providers (except in emergencies).
Fee-for-Service (FFS): With an FFS, healthcare providers are paid separately for each service they provide.
High Deductible Health Plan (HDHP): An HDHP is a health insurance plan that features higher-than-normal deductibles. These high deductible amounts are usually intended to lower your monthly premium payments.
How many people does it take to be considered a "family"?
Where do I find family plans in my area?
If you need more help, there are independent resources you can use. Companies like GoHealth have independent, licensed insurance agents that offer unbiased guidance based on your situation.
Find the Medicare Advantage plan that meets your needs.
Sources
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.