Choosing between the different health care plans can be difficult and confusing for many people. Trying to find a plan that best suits you and your families requirements is not a simple task. Most health care plans differ in the way they work and how much you pay for your premium and your co-pay amount. You will find that some plans will pay for some medical services more than others. Also you really need to look at what your individual requirements are. Most medical plans today center most of their benefits towards preventing ill health and reducing the need of medical attention by providing most of their coverage on preventative visits and treatments. Many companies also make it a requirement to have adequeate health screening and won’t even pick you up if you have a pre-existing condition. Check to see if premiums are higher for people with chronic illnesses, such as diabetes or hepatitis, or for smokers. There are two dissimilar types of medical coverages available, indemnity or fee-for-service, and managed care.
The Indemnity Health Care Plan allows you to use any medical source you want to and not need to get any referrals when seeking specialized medical 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 must to be met each year before the insurance company actually starts paying for medical expenses. These deductibles can range depending on the plan you need and are typically between $200 and $1000 per year. The company will then start to pay a part of the bill; more often than not 80% is the standard. You would then be liable for the other 20%. Depending on your doctor you might be responsible for this expense at the time of treatment. Some doctors will bill you at a later date, but that is uncommon. Usually these types of plans will pay for treatment and prescriptions but not be very preventative friendly. You might find you have to pay for routine physicals and the like with type of plan.
Managed health care is the medical 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 medical plan. It has made provisions with doctors, hospitals, and other providers who have agreed to accept lower fees from the insurer for their services. As a result, visiting any of the doctors listed on the their 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 within the network first. That is where PPO differs from indemnity plans. You will pay a small co-pay when you go to the doctor. But you are covered when it comes to physicals. When you do go outside of the preferred provider network you will be responsible for the co-pay and any extra money that the doctor charges, so your portion will be higher.
Health Maintenance Organization (HMO)
HMOs are the oldest form of managed care plan and been in existence 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.
