Health
Fact-checked

At WiseGEEK, we're committed to delivering accurate, trustworthy information. Our expert-authored content is rigorously fact-checked and sourced from credible authorities. Discover how we uphold the highest standards in providing you with reliable knowledge.

Learn more...

What is a Health Care Plan?

Tricia Christensen
Tricia Christensen
Tricia Christensen
Tricia Christensen

A healthcare plan might be better called healthcare insurance but there are some differences. Usually plan means the details of insurance offered (what they cover), and a single insurance company may offer numerous different types of plans to private individuals or to companies. When a person participates in a health care plan, they get a set of rules that define exactly what will be covered and to what extent coverage can exist. Plans exist for lots of different types of health care. Some might be restricted to vision care or dental care, and others are used for most medical care and exclude vision or dental coverage.

The typical health plan that covers most medical services first defines what type of plan it is. Some plans mean belonging to a health maintenance organization (HMO), which usually means insurance will not cover service with doctors or other medical professionals that don’t participate in the organization, though there are exceptions. Another kind of health care plan is the PPO or preferred provider organization. People usually get lower rates when they visit providers that have signed up with the plan, but they may have the option to see doctors or others who don’t participate in it, usually at a higher cost. Major medical plans are a third option in which the insurance company will pay a percentage of health care costs, usually not dependent on physician enrollment.

HMO benefits cover a variety of health care situations, including preventative care, therapeutic care, and long-term care in some cases.
HMO benefits cover a variety of health care situations, including preventative care, therapeutic care, and long-term care in some cases.

A few plans don’t fit fully into one category or another and are a blend of several different methods. Insurance companies may also offer several types of plans. They could have HMOs and PPOs for instance, or major medical and a PPO. It truly depends upon the insurance company.

It’s unlikely that a person’s health care plan will look identical to someone else’s, unless the two people work for the same company. Plans may offer greater or less coverage depending upon what individuals and companies who may employ them are willing to pay. Larger companies with many employees may be able to negotiate lower rates for a plan, or might be able to get more coverage, but this might also depend in part on the continued health of employees.

Health care plans may offer specific levels of coverage based on what individuals and companies are willing to pay.
Health care plans may offer specific levels of coverage based on what individuals and companies are willing to pay.

Amount of coverage and what people can expect to pay, especially from a health care plan purchased at work, can change on a yearly basis. Companies also can contract with different insurance companies and change this from time to time if they find better coverage for their employees or lower prices that the company will pay. Individuals participating in large systems like Medicare, or the US State Children’s Health Insurance Program (SCHIP) may also need to review several plans to find out which one seems to offer the best coverage, as do those purchasing insurance privately.

A health care plan covers different types of insurance coverage.
A health care plan covers different types of insurance coverage.

Some things to evaluate when choosing a health plan include monthly cost to participate, restrictions on what doctors are available, and things like share of cost or copayment fees. It also helps to know if a health care plan has a maximum lifetime coverage limit or if there are high deductibles that must be paid prior to coverage by the company. Sometimes paying a higher monthly fee means people get more extensive coverage with lower copayments or deductibles. However, for individuals who don’t have access to health care through work or another program, bare minimum health care plans may cost a great deal of money and they may have noted exclusions, especially in covering any conditions that pre-existed or were present prior to purchase of the plan.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent WiseGEEK contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Learn more...
Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent WiseGEEK contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Learn more...

Discussion Comments

Rundocuri

@heavanet- Just because you can't get a dental health insurance plan from your employer doesn't mean that you can't get quality coverage. There are many dental plans available from reputable companies that have large networks and cover necessary dental needs.

When you begin shopping for your plan, keep in mind that regardless of where you get your dental insurance, there are limits to what is covered. Most plans have set maximums that they will cover annually, and many procedures are only covered at about 50 percent. This means that you will have to pay the other 50 percent out of your pocket. However, usually in-network dentists offer lower rates to insured clients.

Since dental procedures are so costly, having a plan will save you money even if it has limited coverage. Look for a plan that is in network with your dentist and covers at least two annual visits for routine care. If you have dental issues, you might want to get a more costly plan that covers more of the cost. If not, a basic plan will still cover a portion of the costs of basic care like fillings and crowns.

Heavanet

My employer doesn't offer a dental health care plan, so I am shopping around for an individual plan. I want to make sure that routine visits and necessary dental care are covered. How can I be sure that I choose the best plan for my dental needs?

Post your comments
Login:
Forgot password?
Register:
    • HMO benefits cover a variety of health care situations, including preventative care, therapeutic care, and long-term care in some cases.
      By: WavebreakmediaMicro
      HMO benefits cover a variety of health care situations, including preventative care, therapeutic care, and long-term care in some cases.
    • Health care plans may offer specific levels of coverage based on what individuals and companies are willing to pay.
      By: Kenishirotie
      Health care plans may offer specific levels of coverage based on what individuals and companies are willing to pay.
    • A health care plan covers different types of insurance coverage.
      By: ronstik
      A health care plan covers different types of insurance coverage.
    • An HMO plan typically does not cover services rendered by doctors who are not involved in the organization's network.
      By: Monkey Business
      An HMO plan typically does not cover services rendered by doctors who are not involved in the organization's network.
    • The cost and amount of coverage from a health care plan can change on an annual basis.
      By: phasinphoto
      The cost and amount of coverage from a health care plan can change on an annual basis.
    • With a PPO, patients can see any doctor they wish, usually within a preferred network of providers.
      By: Monkey Business
      With a PPO, patients can see any doctor they wish, usually within a preferred network of providers.
    • Many health care plans require patients to pay copayments when receiving medical services..
      By: Kzenon
      Many health care plans require patients to pay copayments when receiving medical services..