Everyone should have basic health insurance, but what do you need to be covered? If you’re employed full-time, many employers provide health insurance as a benefit and you should take advantage of everything they offer. If you don’t have health insurance that is covered by your employer, where should you turn. Well, iGrad has partnered with eHealthInsurance to offer you a free health quote. But there’s a lot more to know about health insurance than just getting a free quote.
HMO, PPO – What Does it All Mean?
Millions of people, smart people, are at a total loss when it comes to understanding the jargon of the health insurance industry. And without that understanding, choosing a good health plan is a shot in the dark.
Before you start shopping for health plans, you need to understand one thing: coverage. Although the same condition - emergency care, let's say - is included in many plans' coverage, it doesn't mean that a plan pays for 100% of the cost of emergency care. Some plans cover 80% of the expenses incurred, others 50%. When you shop for health plans, what you're really shopping for is the kind of coverage that's most beneficial to you.
Having said that, you now need to know that there are four basic types of health plans available to people who do not receive Medicare or state subsidized care. A basic understanding of each is essential to choosing one that works for you.
Indemnity Insurance: (also called Fee-For-Service)
This is the traditional insurance coverage you're probably familiar with. It pays for most of your health problems, but doesn't usually pay for preventive care like well-child visits and physical exams. Indemnity insurance doesn't cover the total cost. Coverage is usually limited to a percentage of the billed amount. Under an indemnity plan, you can see any doctor or hospital you want, but the monthly premium is usually higher than other types of health plan.
HMO: Health Maintenance Organization
An HMO covers most of your health care needs, including checkups, immunizations and hospitalization, for a small co-payment typically between $5 and $40. With an HMO there are no claim forms but you can only use doctors and hospitals affiliated with your plan. A list of affiliated physicians is provided by the HMO.
An EPO (Exclusive Provider Organization) is a similar type of plan which functions in much the same way as an HMO.
PPO: Preferred Provider Organization
A PPO covers many of your health care needs for a small per-visit fee if you choose from the list of "preferred providers." You can choose to see a doctor who's not on the list, but you'll foot a greater part of the bill and may have to pay a deductible. Some PPOs do require claim forms.
POS: Point of Service
A POS plan gives you two different choices each time you use health care services: One choice is to use the plan just like an HMO, and you will be responsible for a nominal co-payment, for choosing physicians who are on the list and for obtaining authorizations for certain services and referrals to specialists. Your other choice is to use your health plan just like an indemnity plan by choosing care from either a participating provider or a non-participating provider, without coordinating care through your primary care physician or health plan. When using your health plan like indemnity insurance, you are generally responsible for a deductible and a percentage of your bill.
The Best Time To Think About Health Insurance Is Before You Need It.
Don't wait until you're sick to look for a health plan. Not only does it take time to find a plan you like, many plans have pre-existing condition exclusions, which could leave you out in the cold. Think ahead. Are you planning a family? Will you need surgery soon? Will you be moving out of the area?
If you or your spouse is employed and want to change plans under your employer, ask about open enrollment. But don't wait until the last minute to start shopping around. Give yourself two months to do your homework for the best results.
If your employer doesn't provide health insurance, you'll need to focus on health plans that offer insurance to individuals. You might also investigate associations that offer members the opportunity to join a health plan.
Remember, your health plan is as good as the physicians in it.
A Good Health Plan starts with the Doctor.
The first step in choosing a health plan that's right for you is choosing a doctor who's right for you. If you have a doctor you like, find out the plans in which he/she participates. Next, consider your special medical needs. If you regularly see a particular cardiologist, allergist or any other specialist, you may want a plan that lets you continue doing so without a referral. (This is especially true when choosing an HMO, which may require an authorization to see certain specialists.)
Lastly, think of the hospitals and health facilities you like. Do certain facilities specialize in medical areas that are of particular importance to you? Is one facility more convenient than another? Find out which hospitals are affiliated with which plans.
Choosing the Right Coverage.
A few pointers to help you choose the right coverage for you.
You're single, you earn a good wage, and (lucky for you) you're the picture of perfect health.
Since you rarely see a doctor, your best bet is to choose a plan with a low monthly premium and a higher co-payment. But you should also look for a plan with good coverage in areas that are important to you, e.g., routine physicals, emergency care.
You're a family of four and your oldest is about to start kindergarten.
You'll soon be seeing your pediatrician more than you see some friends. You'll want a plan with low copayments because those visits will really add up. Immunizations, checkups and prescriptions should all be covered expenses. If you already have a pediatrician you like, choose a plan with which he/she is affiliated. You'll also want to make sure a covered urgent care center and hospital are nearby.
You're married and planning a family.
You need a health plan with good maternity and well-child care. Maternity care should include prenatal, delivery and nursery care that begins at the moment of birth. Ideally, you should also plan for unforeseen circumstances like emergency cesarean section and infertility problems. Well-child care will be important to monitor the progress of your healthy baby until 2 years of age. Routine checkups and immunizations should be part of the coverage. Look for a plan with low co-payment since you'll be seeing your doctor a lot.
Let's say you're a 40-50 year old with a modest monthly income.
You've just been diagnosed with a knee problem for which you'll have to undergo ongoing treatment. You'll need a health plan that lets you see the specialists you want as often as you want to. You'll be taking prescriptions, so you'll want to make sure those are covered expenses. Since your income is modest, low co-payments are important. You may pay a higher premium to get the coverage you want, but the advantages will be worth every cent.
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