Health Insurance Choices and Education

Health Choices & Education

Understanding Health Insurance

Types of Plans

While companies offer their own blend of benefits and pricing, most plans fall into several main types.
  • Choice of doctors:  Consider a PPO plan.
  • Lower costs:  Look for HMO plans.
  • Balance between doctor choice and affordable cost:  Check out PPO plans and HMOs.
  • Help if you are having trouble getting major medical coverage: Read about limited-benefit plans and state programs.
Most of these types of plans require you to pay similar types of costs, i.e. premiums, deductibles, copays.
  • Preferred Provider Organizations (PPOs)

Medium Cost, Moderate Choice

A PPO  plan uses a very large network of preferred providers to give you access to a wide range of health services. PPO’s also reprice all medical services, saving you and the insurance company money.  Also, you can decide to see out-of-network doctors and still get some coverage. However, the plan will pay more of your costs if you see an in-network doctor.

Advantages

  • Greater choice of doctors.
  • Ability to receive care from a doctor or hospital outside the plan’s network (at a higher cost to you).
  • All medical services are repriced saving you money

Disadvantages

  • Extra cost to access providers who are not in the plan’s network.
  • More paperwork than an HMO plan if you use out-of-network doctors.
  • Health Maintenance Organizations (HMOs)

Less Cost, Less Choice

HMO plans are known for lower cost, less hassle, and as the tradeoff, limited choice of doctors.   Traditional HMOs rely on agreements with a network of healthcare practitioners and hospitals to provide health benefits at a reduced price. Some even have a staff model in which all of the doctors and other healthcare providers are employed by the HMO.
One monthly premium can give you a full range of services:
  • Doctor visits
  • Hospital stays
  • Emergency care
  • Surgery
  • Lab tests
  • Preventive care
Typically, an HMO plan will assign you to the care of a primary care doctor who will coordinate all of your healthcare. This is the doctor you will see whenever you need care. If you need to see a specialist, your primary care doctor will need to write you a referral. The specialist will most likely also be in the HMO’s network or employed by the HMO.

Advantages

  • Total costs are usually lower than  Preferred-Provider (PPO) plans.
  • A wide range of services is included such as preventive care and checkups.
  • Little or no paperwork — just show an insurance card at appointments.

Disadvantages

  • Choice of doctors, hospitals, and prescription medications are restricted.
  • Your primary care doctor will need to pre-approve any visits to specialists.
  • Lack of choice and volume of patients in the plan could mean it takes longer to get an appointment.

 

 

Questions To Ask

Regardless of the type of insurance you are looking for, when you are considering a plan, you will want to ask some key questions. Here is a list:
  • Will this plan let me choose the doctors and hospitals I want to use? How much more will I have to pay if I choose a doctor or hospital outside of the plan’s network?
  • How much is the monthly premium?
  • How much is the yearly deductible?
  • Will I have to pay a percentage of my healthcare bills coinsurance?
  • Will I have to pay any co-pays when I see a doctor or buy medicine?
  • Does the plan have an out-of-pocket limit, which is a ceiling on how much I will pay in any year?
  • What is the policy’s lifetime limit?
  • How does the plan cover prescription drugs? Can I save money through a mail-order program?
  • What services are covered?
  • If I have a serious health problem, will the plan cover it, and cover it right away?
  • Does the plan offer guaranteed renewability, meaning that the policy cannot be canceled if I become ill?
  • Does the insurance company selling the plan give me tools on their website that can help me manage my care? Ask about tools such as: a personal health record that contains your test results and prescription information, health risk assessment that helps you identify conditions you might be at risk for, information on doctor and hospital quality and prices, and personalized health information and alerts.
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