Search MyHealth

How Insurance Works

What Insurance Does Spectrum Health Accept?

Spectrum Health accepts many different health insurance plans, as well as Medicare and Medicaid. 

If you’re shopping for health insurance, we can help you navigate through the many types of plans available. Every plan offers different coverage and provider networks―meaning you’ll want to make sure the plan you choose works best for your family’s specific health situation. 

Some plans have a very limited network, which means you can only see specific doctors and receive care at specific hospitals. If you want to keep your current primary care physician, be sure to check if he or she is included in the list of providers from that plan.

How Insurance Works

Health insurance is usually paid for with a monthly premium. In addition to your premium, most plans have a deductible: the amount you owe for covered health care services before your health insurance plan begins to pay. For example, if your deductible is $1,000, your plan starts paying for covered services after you pay the first $1,000. 

Most plans also include a co-payment: the amount you pay for covered services, such as doctor appointments or physical therapy.

Plans with lower monthly premiums usually have a higher deductible or co-payment when you receive care. Depending on your health circumstances, a plan with a higher monthly premium and lower out-of-pocket expenses may make more sense for you.

Different Types of Insurance

Not all health insurance plans are the same. Our Spectrum Health financial counselors can walk you through the process of selecting and enrolling in insurance coverage to meet your family’s needs. 

HMOs generally have the lowest monthly premiums. You’ll need to choose an in-network primary care provider (PCP). HMOs usually include a large network of health care providers, hospitals, clinics and labs, to cover the care you need. With an HMO, you can see a specialist without a referral. 

PPOs
often have the highest premium, but offer the greatest flexibility to see PCPs in and out of network.

POS
plans combine the benefits of an HMO with a little more flexibility. A primary doctor coordinates your care. You’re covered for in-network and out-of-network and there’s no need for a referral to see a specialist.

Narrow network plans offer low premiums and access to a limited network of providers and hospitals, and their affiliated clinics, outpatient facilities, labs and more. Care outside of the network is not covered.

For more information, visit the information desk at any Spectrum Health facility.

The Affordable Care Act

The Affordable Care Act (ACA) specifies that all health insurance plans offer basic medical care, including annual physicals and recommended preventive services. The ACA also specifies that you cannot be refused insurance coverage because of a pre-existing condition.

The ACA’s Exchange Marketplace offers lower-cost insurance plans to all who qualify, based on financial need.