← All articlesHealth plansHMO vs. PPO: Which plan type fits you?
DVS Health · For general information only; plan details vary.
When you compare health plans, one of the first labels you’ll see is the plan type. The two most common are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations). Neither is better across the board — they trade cost for flexibility.
How an HMO works
An HMO has a defined network of doctors and hospitals. You typically choose a primary care doctor who coordinates your care and gives referrals when you need a specialist. Except in emergencies, care outside the network usually isn’t covered.
How a PPO works
A PPO also has a network, but you can see specialists without a referral, and the plan pays part of the cost when you go out of network. That freedom usually comes with higher premiums and sometimes higher deductibles.
| HMO | PPO |
|---|
| Monthly premium | Usually lower | Usually higher |
| Specialist referrals | Usually required | Not required |
| Out-of-network care | Generally not covered (except emergencies) | Partly covered |
| Best for | People happy with in-network doctors who want lower costs | People who want flexibility or see out-of-area doctors |
You may also see EPOs (a network with no referrals but no out-of-network coverage) and POS plans (an HMO-style plan with some out-of-network benefits).
Tip: Before choosing, check that your doctors, hospital and prescriptions are covered. We do this for you when we compare plans.
← All articlesHealth plansDeductibles, copays and out-of-pocket maximums, explained
DVS Health · For general information only; plan details vary.
A plan’s premium is only part of the story. What you pay when you actually use care depends on four numbers.
The four numbers that matter
- Premium — what you pay every month to keep coverage.
- Deductible — what you pay for covered care each year before the plan starts sharing costs.
- Copay / coinsurance — your share after (and sometimes before) the deductible: a flat copay like $30, or a percentage like 20%.
- Out-of-pocket maximum — the most you’ll pay for covered in-network care in a year. After that, the plan pays 100%.
An example
Say your plan has a $3,000 deductible, 20% coinsurance and an $8,000 out-of-pocket maximum, and you have a $20,000 covered hospital stay. You pay the first $3,000, then 20% of the remaining $17,000 ($3,400), for a total of $6,400 — still under your $8,000 maximum.
Low premium or low deductible? If you rarely see a doctor, a lower premium with a higher deductible can save money. If you expect regular care, ongoing prescriptions or a procedure, a plan with lower out-of-pocket costs may cost less overall.
Many plans also cover preventive care at no cost, and some cover doctor visits or generic drugs before the deductible. Those details can change which plan is the better value for you.
← All articlesHealth plansMarketplace plans vs. private health insurance
DVS Health · For general information only; plan details vary.
“Health insurance” can mean very different products. Knowing the difference between Marketplace and private plans helps you avoid surprises.
Marketplace (ACA) plans
- Sold through HealthCare.gov or your state’s exchange (and through licensed agents like us).
- Cover the ACA’s essential health benefits, and can’t deny you or charge more for pre-existing conditions.
- May qualify you for premium tax credits based on household income, which can lower your premium significantly.
- You enroll during Open Enrollment, or with a qualifying life event.
Private and short-term plans
- Bought directly from a carrier, outside the Marketplace.
- Some are medically underwritten: the carrier can review your health history, and pre-existing conditions may be excluded.
- No tax credits, but for some healthy people who don’t qualify for subsidies, premiums can be lower.
- Short-term plans offer temporary coverage and can often start quickly, but have limits on benefits.
Which is right? If you qualify for tax credits or have ongoing health needs, a Marketplace plan is usually the safer choice. If you’re healthy and don’t qualify for help, a private plan may be worth comparing. We’ll show you both.
← All articlesMedicareMedicare Advantage vs. Medicare Supplement
DVS Health · For general information only; plan details vary.
Original Medicare (Parts A and B) covers a lot, but not everything — and it has no yearly cap on what you can spend. Most people add coverage one of two ways.
Medicare Advantage (Part C)
A private plan approved by Medicare that replaces Original Medicare for your coverage. Many include Part D drug coverage and extras like dental, vision or fitness benefits, often for a low or $0 extra premium. Most use networks (HMO or PPO), and there’s a yearly out-of-pocket limit.
Medicare Supplement (Medigap)
Works alongside Original Medicare and pays some or all of the costs Medicare leaves behind, like deductibles and coinsurance. You can see any provider that accepts Medicare. Premiums are usually higher, and you’ll typically add a separate Part D drug plan.
| Medicare Advantage | Medicare Supplement |
|---|
| Doctors | Usually a network | Any provider that accepts Medicare |
| Premium | Often low or $0 (plus Part B) | Higher monthly premium |
| Costs when you get care | Copays, up to a yearly limit | Little or nothing, depending on the plan letter |
| Drug coverage | Usually included | Separate Part D plan |
Timing matters. Your Medigap Open Enrollment (the six months after you’re 65 and enrolled in Part B) is when you can buy any Medigap plan without health questions in most states. The Annual Enrollment Period, October 15 to December 7, is when you can change Medicare Advantage and Part D plans.
← All articlesDental & visionDo you need dental and vision insurance?
DVS Health · For general information only; plan details vary.
Most medical plans don’t cover routine adult dental or vision care, so many people go without — until a crown or new glasses arrives with a big bill.
What dental plans cover
Most dental plans cover preventive care (cleanings and exams) at or near 100%, basic care (fillings) at a lower percentage, and major care (crowns, root canals) at a lower percentage still, up to an annual maximum. Major care often has a waiting period before it’s covered.
What vision plans cover
A yearly eye exam plus an allowance toward glasses or contacts. If anyone in your household wears glasses, a vision plan often pays for itself.
Worth it? If you visit the dentist twice a year, expect dental work, or buy glasses or contacts regularly, a dental or vision plan usually saves money. Add the premium for a year and compare it to what you’d pay out of pocket.
← All articlesSupplementalWhat is supplemental insurance — and who needs it?
DVS Health · For general information only; plan details vary.
Even good health insurance can leave you with a large deductible and coinsurance after an accident or serious diagnosis — plus time off work. Supplemental insurance helps cover those gaps.
Common types
- Accident — pays set amounts for injuries like fractures, ER visits and hospital stays.
- Critical illness — pays a lump sum if you’re diagnosed with a covered condition like a heart attack, stroke or cancer.
- Cancer — benefits for treatment and related costs after a cancer diagnosis.
- Hospital indemnity — a daily or per-stay benefit when you’re admitted.
Benefits are paid to you, so you can use them for medical bills, rent, groceries or travel for treatment.
Good fit if: you have a high-deductible health plan, limited savings, an active lifestyle or physical job, or a family history of serious illness. Supplemental plans don’t replace major medical coverage — they work alongside it.
