What type of health insurance is blue cross blue shield

Choosing a health care plan can be overwhelming. You have to decide between an HMO and a PPO, and if you want an HSA. It helps to know how you like to manage your care and if you want a plan that helps you save on taxes. Our health plan advisors can help you decide. Watch this video or read the transcript below to get started.

Plan Types

Plan types (HMO, PPO) refer to how plans provide coverage and from which network of providers you receive care.

Health Maintenance Organization (HMO)

HMO plans offer the flexibility to see any of the 44,000 participating providers in the BlueChoice network. Outside of our network, only emergency medical services are covered.

Preferred Provider Organization (PPO)

PPO plans offer the most flexibility. Care can be accessed from the PPO network of more than 47,000 providers locally and thousands nationally. Costs will be higher if you see a doctor who does not participate with a Blue Cross and Blue Shield plan.

Catastrophic plans, like our BlueChoice HMO Young Adult plan, usually have lower premiums than a comprehensive plan, but have higher deductibles. The BlueChoice Young Adult plan is available to individuals under the age of 30 at the time of their effective date. Please note, certain individuals age 30 or older may also apply for BlueChoice Young Adult if their policies were cancelled due to non-compliance with the Affordable Care Act or if they quality for a hardship exemption.

Medicare

For people 65 or older, or younger people with a disability or special condition

Businesses

Administrators and employers shopping for group plans.

Health solutions at the center of everything we do.

Virtual Care

Your health care shouldn't be limited by your location. With virtual health care, you have access to providers 24/7, and you can access care that works for your schedule.

Florida Blue Centers

See a nurse. Take a class. Get health assessments, treatment support, and help understanding your plan. All here in your neighborhood.

Low or No Cost Providers

During these uncertain times, count on partners like Sanitas and other value-choice providers to provide high-quality care at a lower price than other networks.

What else can health insurance do?

It's a question we ask ourselves every day… For more than 75 years, Florida has been our one and only home. Helping you and our communities be as healthy as they can be is our mission and we will never stop finding new health solutions to achieve it.

Support during COVID-19

We want to make sure you get the care you need. We're making it easier for members to get vaccinated, tested and treated for COVID-19 and have increased access to other health care services.

We are passionate about helping people and communities achieve better health.

Florida Blue is a part of the GuideWell family of companies. Together, we're committed to making a meaningful difference in the health of all Floridians. Read about our progress in the 2021 GuideWell Social Impact Report.

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Last Updated: 10.01.2022
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Making Sense of Plan Types

There’s a lot to learn about health insurance. And all the acronyms and terms you hear when looking at different plans, like HMO and PPO, may be confusing. But don’t worry – we’ll make it easy by breaking down what each of these plan types are and how they are different.

Four Common Types of Health Insurance

If you’re looking for health insurance, especially in the Marketplace, you may find these four common plan types: HMOs, PPOs, EPOs, and POS plans. There are so many different plan types to help ensure that different needs can be met. Many of the differences between these plans can be found in their networks and associated costs. Here’s a look into what defines these four main types of individually purchased non-Medicare health insurance plans.

HMO: Health Maintenance Organization

Health maintenance organization plans, or HMO plans, offer a wide range of health care services through a specific, local network of participating health care providers, hospitals and facilities. Generally speaking, you must have an in-network primary care physician, or a PCP, with an HMO plan. Not only is your PCP your main point of contact for your health care needs, but they also need to provide you with referrals should you need to see an in-network specialist.

Main features of HMO plans:

Lower costs (copays and coinsurance) than other types of health plans if your care is all in-network
A dedicated primary care doctor who can coordinated all your care needs
Referrals required to see specialists
More defined network of doctors, hospitals and facilities
No out-of-network coverage for non-emergency care with few exceptions

PPO: Preferred Provider Organization

Preferred provider organization plans, or PPO plans, offer you more options for health care providers. Their networks tend to be larger, so you have more doctors and hospitals to choose from. While you’re able to see out-of-network providers with a PPO plan, you may pay higher out-of-pocket costs than you would with in-network providers. With a PPO plan, you’re not required to have a primary care doctor and can see specialists without a referral.

Main features of PPO plans:

A larger network of providers and hospitals
Lower costs when you use in-network providers
The option to use out-of-network providers and hospitals for an additional cost
Generally higher out-of-pocket and premium costs than HMOs
The ability to see a specialist without a referral from a PCP

EPO: Exclusive Provider Organization

Exclusive provider organization plans, or EPO plans, are like HMO plans in that they have a specific network of providers that members must use, except in the case of an emergency. Outside of emergencies, there is no coverage for out-of-network providers with few exceptions. However, like with PPO plans, most EPO plans don’t require you to have a PCP and you do not need a referral from a PCP to see a specialist.

Main features of EPO plans:

Generally lower premiums than PPOs
No out-of-network coverage for non-emergency care
More defined network of doctors, hospitals and facilities
The ability to see in-network specialists without a referral from a PCP

POS: Point of Service

Point of Service plans, or POS plans, are like a combination of HMO plans and PPO plans. Like with an HMO, you may be required to have an in-network primary care doctor. This PCP should refer you to any specialists needed, but like with a PPO plan, you are able to see out-of-network specialists for a higher out-of-pocket cost.

Main features of POS plans:

Lower cost when you use in-network providers and hospitals
The option to use out-of-network providers and hospitals for an additional cost
A dedicated primary care doctor who can coordinate your health care needs
Referrals required to see specialists

Frequently Asked Questions

While PPO plans can be more expensive than HMO plans, they offer out-of-network coverage that HMO plans do not offer. This gives you a choice of more doctors and specialists.

Short-term health insurance plans, also called short term limited duration plans, offer health coverage for people who may be in-between jobs, need coverage outside of the annual Open Enrollment Period and don’t qualify for a special enrollment period or are waiting to be eligible for Medicare. Typically, these temporary health insurance plans can cover you for as little as 30 days to a maximum of 364 days.

High-deductible health plans, or HDHP plans, can be any of the types of health insurance plans listed above (HMO, PPO, EPO or POS). However, these plans are specifically designed to be used in conjunction with a health savings account, or an HSA. An HSA is a bank account that allows you to save pre-tax money to be used exclusively for qualified medical expenses. Unused funds in an HSA account roll over every year, but you can’t use the funds outside of qualified medical expenses without paying a penalty. Because they are often used side-by-side with an HSA, HDHP plans have higher out-of-pocket costs but offer a lower premium.

Main features of HDHP plans:

Higher deductible and out-of-pocket costs
Lower premium payment
A health savings account (HSA) to help pay for your care with tax-free money that rolls over each year

The best type of health plan for you will depend entirely on your specific financial and health care needs. For instance, if you currently use or expect to have more intensive care needs than just preventive services, the best type of plan for you might have lower out-of-pocket costs (especially a lower deductible and coinsurance) so you know what to expect to pay.

If you’re healthy and don’t expect to need much medical care outside of preventive visits, a plan with a higher deductible and a lower monthly premium could help you save money while still giving you the coverage you need to stay healthy.

Learn More About Health Insurance

How Much Does Health Insurance Cost? >
Learn more about the price and value of health insurance plans so you know what to expect financially.

How to Choose a Plan >
Ready to take the next step? Explore our guide on how to choose the right plan for you when shopping for health insurance.

Policies have limitations and exclusions. The amount of benefits provided depends on the plan selected and the premium may vary with the amount of benefits selected.

Is Blue Shield different from Blue Cross Blue Shield?

Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services. Blue Cross is a name used by an association of health insurance plans throughout the United States.

What type of insurance is Blue Cross Blue Shield of Illinois?

Blue Cross and Blue Shield of Illinois (BCBSIL) is a customer-owned health insurance company serving Illinois residents. The company offers individuals and families healthcare and prescription drug coverage through its Blue Choice Preferred PPO, Blue Precision HMO, and BlueCare Direct HMO plans.

Is Florida Blue a PPO or HMO?

Florida Blue HMO Plans Our HMO plans offer over 7,000 in-network primary care providers (PCPs) and over 9,000 pharmacy locations to choose from! Not only is your PCP your main point of contact for your health care needs, but they will also provide you with referrals should you need to see an in-network specialist.