The Different Kinds of Health Insurance
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Choosing a health insurance plan from your company’s menu of options or from a website can feel a lot like ordering dinner for you and your date at a pretentious French restaurant when you don’t speak French.
Health insurance policies come in all shapes and sizes with complex nuances that make them difficult to understand. Yet these days, individuals are increasingly tasked with figuring out on their own what the best plan is for them, and possibly their family.
In order to make the right decision, you need to understand your basic options. We’ve defined and described the main dishes below:
HMO (Health Maintenance Organization) – One of the cheapest options, HMOs don’t give you a dime if you see an out-of-network doctor. For some people, this is a dealbreaker, since their beloved internist or dermatologist is not affiliated with the HMO on offer. Also, HMOs require you to select a primary care physician, which means you need to get a referral from him or her before you can see any specialists.
But if you like the doctors in an HMO’s network, it’s mighty simple and cheap: There’s no deductible and most routine things are covered at 100% once you fork over a small copay. No muss, no fuss.
EPO (Exclusive Provider Organization) – This plan is basically an HMO, but with a nationwide network as opposed to a regional one.
PPO (Preferred Provider Organization) – This plan also has its own network of doctors, and when you use them it functions mostly like an HMO (small copays, extensive coverage). But you don’t need a PCP (shorthand for primary care physician) for referrals—so you can schedule appointments with any doctor at any time—and you have the option to use a doctor who’s not in the network and still get some coverage (like, for example, 70% of reasonable, usual and customary). If you feel like you’re going to want the greatest selection of doctors, a PPO is your best choice, but you’ll pay for the privilege: PPOs tend to have some of the highest premium costs.
POS (Point of Service) – Imagine an HMO that lets you go out of network. “Ah, but that’s a PPO, right?” Not quite. You’d still be required to have primary-care physician, and you’d still have to go to your PCP to get referrals. But if you went out of network, you’d get some coverage too—just not as much out of network coverage as a PPO would provide. Got it? That’s a POS plan.
High Deductible/Catastrophic/Safety Net Plan – This option goes by many names, but its appeal is the same: Let’s say you don’t need a doctor on a regular basis, but you want something protecting you in case you get hit by a car. Instead of a deductible that’s $250, like in a PPO plan (or $0 if you were in an HMO), your deductible would be more like $2,500. Once you paid that, however, coverage would kick in at 100%. Also, your premiums would be the lowest of all of the health plans (as much as one quarter the cost of the most expensive PPO, if your deductible is sky-high).
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The Different Kinds of Health Insurance:
A very good explanation of the different kinds of health insurance, but I would like to add a point that should be highlighted in my opinion.
To the best of my knowledge however, unlike a PPO health insurance plan, a HMO does not provide health insurance benefits out-of-network for routine medical situations. Emergency situations such as a bad traffic accident as an example, the insured is covered as an in-network situation until such time that the patient is stabilzed and can safely moved to an in-network provider hospital.
Edwin J. Tazelaar, II
Edwin J. Tazelaar, II Insurance Agency
www.EdTazelaar.com
(800) 393-4303
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