Medical Guidance – Learning the Basics About Health Care and Determining the Best Health Insurance Plan For You
Are you shopping for a new health insurance plan? Before you take another step, you need to understand first the 4 types of Individual and Family Plan and the differences between each. Only then can you proceed with shopping for a new plan. You need to get to this step first since it is what will guide you in knowing which health plan is best for you and your family. It helps you choose the most suitable plan for your health care needs as well.
The 4 Types of Health Plans
- PPO or Preferred Provider Organization
It is considered as the most popular plan when it comes to the Individual and Family market. As what the name implies, your medical care should come from the preferred providers of your insurance company. It is how you can get the highest level of payment from your claims if it is what you are after. If you choose this, it becomes your responsibility to know if the health care providers you visit are part of PPO. If not, the services rendered may not be paid at the lower level or covered at all.
This medical plan is ideal for you if your favorite or preferred health care provider is already participating in PPO. In this case, you can simply opt for the plans that your doctor accepted and get quotes at eHealthInsurance. It is also the ideal type of plan for you if you wish to have some freedom to decide on your health care and it is fine with you to work with health care providers that are on the given list.
- HMO or Health Maintenance Organization
HMO is planning on offering a wide array of health care services through multiple providers that are exclusively on contract with them. The plan also involves a network of health care providers who agree to render services to the members. If you are an HMO member, you are required to pick your primary care physician. This provider will be the one to provide you most of your health care needs. If necessary, they can refer you to the same HMO specialists. Just remember though that services rendered will not be covered if it is not from an HMO specialist. However, there might be some instances when it will be.
This is the right plan for you if it is fine with you to follow the rules and direct your care to your PCP. It is also the best option if preventive care services are on top of your priority. That is because these are services that HMOs give more focus on.
- HSA-Eligible Plans
These are also from under PPO plans. However, it involves higher deductibles and are designed to be used with a Health Savings Account – which is a special bank account allowing the savings of money from pre-tax. It is meant to be utilized for future medical expenses. The money in your HAS bank accounts increases every year and can accumulate interest. The main benefit in this type is that it allows you to save money once you pair a qualifying high deductible plan with it. It also allows you to benefit from a tax write-off.
HAS-Eligible plan is for you if you are willing to pay for your health care expenses using pre-tax dollars. It is also ideal for those who are still young and know they are relatively healthy. The plan is the best one for you if you want cheaper monthly premiums even if it has some risks like higher deductibles when an unexpected illness or injury happens.
- Indemnity
It is the plan that allows you to choose your health care as well as visit any hospital or doctor when you like or need to. In this case, the insurance company just pays the set portion to cover the medical expenses incurred. Those who opt for this plan can be required to pay some services and just apply for reimbursement later. The benefit in choosing this is the freedom it comes with. However, it is also considered the more expensive than the rest. Hence, if you are after health care freedom, this is the type of plan that can provide that. But you will need to coordinate your claims’ billing and reimbursement.
The Right Health Insurance Plan For You
In this aspect, you will easily determine what is right for you if you know the things to consider. Of course, it is your priority to choose the health insurance plan that can give most of the services you will come to need at the lowest cost. And there are three things you need to consider if you want to determine the right plan for you. These are:
- Benefits
All insurance plans cover the hospital and doctor bills. But it comes with a number of limits. What you need to keep in mind is that prescription drugs, preventive and psychotherapy care and glasses can either be covered or not and it all depends on the specific plan. To get the most of the plan you will choose and the benefits it comes with, it helps to make a list of all health services you usually use. Consider all plans and take note of the coverage it has with those on your list. Then, evaluate the cost differences.
- Costs
Your indemnity coverage’s primary cost will be on the premium if you are not using that much of medical services. This can be an issue since it will be hard for you to determine the actual costs of the services you might need. However, that is what’s different with HMO because almost everything can get covered as the premium is paid and only leaves you liable for the co-payments.
- Restrictions
A care plan that is managed gives you limit when choosing providers. It also requires getting pre-approval for the services to be needed. This can be hard if you have a severe health problem since you will have a hard time abiding by such limits. Even Indemnity insurance has limitations, which are more on uncovered services, co-payments and deductibles. Hence, it leaves you without the freedom to choose.
Hence, it is truly important to consider every aspect to know the advantages on each type of plan. Only then will you be able to make an informed decision. Of course, it helps to know your providers as well, which means you need to check up on them in advance.