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SolveYourProblem
Article Series:
Health Insurance
What
Are My Choices in Health Care Plans?
Choosing between health plans can be difficult and
confusing for many people. Trying to find a plan that best fits you
and your families needs is not task. Most plans differ in
the way they work and how much you pay as a premium and co-pay.
You will find that some plans will pay for some services
more than others and need to look at what your individual
needs are. Most plans today focus most of their benefits
to preventing illness and reducing the need of medical attention
by providing most of their coverage on preventative visits
and treatments. Many companies also require a health screening
and won’t pick you up if you have pre-existing conditions.
Check to see if premiums are higher for people with chronic
illnesses, such as diabetes or hepatitis, or for smokers.
There are two different types of coverage available, indemnity
or fee-for-service, and managed care.
The Indemnity
Plan allows you to use any medical provider
you want to and not need to get any referrals when seeking
specialized treatment or care. You can also go to any hospital
that you want and not have to worry if you are covered. These
plans tend to have a deductible that needs to be met each year
before they start actually paying for some of the medical expenses.
These deductibles can range depending on the plan you need
and are usually between $200 and $1000 per year. The company
will then start to pay a portion of the bill; usually 80% is
the standard. You would then be responsible for the other 20%.
Depending on your doctor you might be responsible for this
payment at the time of treatment. Some doctors will bill you
at a later date, but that is rare. Usually these types of plans
will pay for treatment and prescriptions but not very preventative
friendly. You might find you have to pay for routine physicals
and the like with type of plan.
Managed
care is the plans most people are used to seeing and
hear most about. There usually are the choices of a Preferred
Provider Organization (PPO), a Health Maintenance Organization
(HMO), or a Point-of-Service Plan (POS). These have some very
similar benefits and you should read carefully through each
one to see the differences and figure out which one would be
best for you and your family.
Preferred Provider Organization (PPO)
A PPO is very similar to an indemnity plan. It has arrangements
with doctors, hospitals, and other providers who have agreed
to accept lower fees from the insurer for their services. As
a result, going to any of the doctors listed on the plan as
accepting this type of insurance, you lower your cost. With
PPO if you want to see a doctor outside the network then you
will need to get a referral from a doctor with in the network
first. That is where PPO differs from indemnity plans. You
will pay small co-pay whenever you go to the doctor and for
prescriptions. But you are covered when it comes to physicals.
When you do go outside the network you will be responsible
for the co-pay and extra money that doctor charges, so your
portion will be higher.
Health Maintenance Organization (HMO)
HMOs are the oldest form of managed care plan and been around
a long time. They offer a range of health benefits, including
preventive care, for a set monthly fee, co-pay on prescriptions,
and no deductible. There are several types of HMOs. There is
the type of HMOs offer at most jobs that is a staff or group
model HMO. Some HMOs contract with physician groups or individual
doctors who have private offices, called individual practice
associations (IPAs) or networks. You will be given a list of
doctors to choose from and will pick one as your primary care
physician. This doctor sees you whenever you have a health
issue and for yearly check-ups. If you need to see a specialist
or other doctor he/she will give you a referral. You will also
need a referral to go to the emergency room in some cases.
With most HMOs you will pay nothing to see your doctor, but
some do have a very small co-pay of $5-$10 per visit. You must
get a referral to go out of the network or be required to pay
for the visit in full. In some cases you might be required
to pay in full if there is a network doctor available and you
refuse to see that one.
What is a Point-of-Service (POS) Plan?
Some HMOs offer an indemnity-type option known as a POS plan.
In this type of HMO, a POS plan, members can refer themselves
outside the plan and still get some coverage. If your personal
doctor refers you to a doctor out side of the network you will
be fully covered by the plan. Click here to to view health insurance quotes, compare plans side-by-side and apply for the most affordable health insurance within your budget. I did this myself (June 17, 2011) to change my health insurance policy. Saved me $84 per month (or $1,008 per year). It's my SolveYourProblem recommendation.
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by SolveYourProblem.com
: 2006
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