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Major Medical Health Plans
Health insurance is one type of insurance you're pretty much guaranteed to use. We all need medical attention from time to time, and some of us need it quite frequently. When care is needed, you want to focus on getting better not on how you're going to come up with the money to pay your medical bills. A good health insurance plan allows you to focus on what's most important, your physical well being. Is there anyone who doesn't need health insurance? Not really. Even if you're young, healthy and haven't had to see a doctor in years, you never know when you might be involved in an accident or be diagnosed with a serious medical condition. While your health insurance coverage will pay for things that aren't too costly like routine doctor's visits or lab tests, the main reason to have coverage is to have protection against the potentially catastrophic expenses of serious illness or injury. Here are some of the type of coverage available:
Fee-for-Service (or Indemnity) Plans)
With this traditional plan, you can make an appointment with almost any medical
provider. After your visit, you or your provider sends your claim to the
insurance company. If you have met your deductible for the year, then the
Fee-for-Service plan will pay a percentage of the bill – usually 80%. You pay
for the other 20%, known as coinsurance.
Managed Care
This term refers to types of health insurance plans that provide health care
services at a lower cost. The key to these lower costs? Members of managed care
plans must adhere to certain rules designed to lower the cost of medical care.
Types of Managed Care:
Health Maintenance Organizations (or HMOs)
With an HMO, you receive a range of health benefits for a set fee. Generally,
there are no deductibles – but most plans require a small co-pay per office
visit (around $10-25). You must choose a primary care physician from the
plan’s list. This doctor becomes your “gatekeeper” for all your medical
needs. This is the doctor you call or see when you are sick, and he or she will
refer you to a specialist or other providers within the HMO network. With most
HMOs you will not receive benefits if you go out-of-network, except for
emergency care.
Preferred Provider Organization (PPO)
This isn't an HMO, but it is another type of managed care. In this system, you
may seek treatment from an approved network of providers, or may see other
providers outside the network. Usually, you will pay small co-pay and satisfy a
deductible before benefits are paid. Then you’ll pay a set co-insurance
amount. It’s less expensive to visit one of the providers in the plan’s
list. You can go outside the plan’s list, but your share of the bill will be
higher.
Point of Service (POS)
A hybrid of the HMO and PPO is known as a POS plan. Like a standard HMO, your
primary care doctors make referrals to other providers within the plan. But if
you want to go to a physician outside the network without consulting your
primary care doctor, the POS plan will pay a predetermined amount of the bill
and your share of the bill will be higher than it would if you stay in-network.
These plans usually cost more in monthly premiums than a regular HMOs, but they
give you more flexibility.
Health Savings Accounts
Health Savings Accounts (HSAs) are a relatively new way to pay for healthcare. Like an IRA, the money deposited into an HSA is completely tax-deductible. These accounts, however, can be accessed whenever individuals need them to pay for qualified healthcare expenses. In the meantime, their money earns tax-free interest for future medical costs which allows you to get the healthcare you need when illness strikes.
- You choose your Plan Indemnity or PPO.
- You control how you manage you healthcare and how it fits your budget
- You select the rate that best fits your family needs.
