What are the Different Types of Individual Health Insurance Coverage?

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  • Written By: Jessica Ellis
  • Edited By: Bronwyn Harris
  • Last Modified Date: 11 March 2020
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Individual health insurance coverage is sold to a consumer directly, rather than being funneled through an employer or benefits program. It can be used to cover single individuals, single parents with dependent children, and families. There are several different types of individual health insurance coverage plans available from numerous health insurance brokers. Insurance experts suggest investing some time in researching and comparing different types of plans in order to find the best deal.

An HMO, or health management organization, is a type of individual health insurance coverage that tries to provide comprehensive care. HMO plans cover services such as annual check-ups, diagnostic tests, and preventative care. Like most health care plans, an HMO is paid for by a combination of monthly premiums and personal contributions toward care. Many people on HMOs are required to pay a co-payment, which is a reduced fee, for each doctor's visit, as well as for prescriptions. One of the downsides to an HMO plan is that many insurance companies assign buyers a primary care doctor, and there is little flexibility for changing physicians.


For people that want to have a greater amount of choice in physicians and specialists, an individual health insurance program called a fee-for-service policy may be a better choice. Though typically somewhat more expensive than an HMO plan, fee-for-service plans allow an individual to go to any doctor he or she wants, including specialists. Fee-for-service plans do frequently involve a lot of paperwork for the user, however, as he or she will need to file and submit claims for each doctor visit or treatment. This type of plan may also have limited emphasis on preventative care coverage, meaning that a person may be responsible for the full cost of services such as well-women exams and immunizations.

A preferred provider organization, or PPO, provides some compromise between the two former types of individual health insurance coverage plans. A PPO allows the buyer to choose his or her primary care physician from a list of network doctors, and gives the buyer the flexibility to change to another network physician at any time. If a person chooses to go to a doctor that is not in the PPO network, the insurance company may still cover some, but not as much, of the cost.

Individual health insurance coverage can also be described in terms of the amount of coverage provided. Some plans offer catastrophic coverage only, which covers fees past a deductible for serious medical issues, such as surgery, cancer treatment, or traumatic injuries. Some comprehensive plans include services from other healthcare areas, such as dental or vision coverage, or coverage for alternative treatments such as chiropractic care. Generally, the more services covered by the plan, the more expensive the monthly premium.



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