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Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and copayments. Here's a list of key questions to consider in selecting the plan that best meets your needs:
The above content was used with permission from the Agency for Health Care Policy and Research and Health Insurance Association of America. A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.
If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs are likely to be somewhat higher. An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.
If you join an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO. "HSA" stands for "Health Savings Account," and Health Savings
Accounts are great news for Americans!
The U.S. Congress recently passed legislation which makes
paying for medical expenses much more affordable for consumers.
As of January 1, 2004, the new law provides broad access to
Health Savings Accounts, which allow consumers to pay for
qualified medical expenses with pre-tax dollars (income-tax
free!) and save for retirement on a tax-deferred basis.
An HSA is tax-favored savings account that is used in
conjunction with a high-deductible HSA-eligible health insurance
plan to make healthcare more affordable and to save for
retirement.
 HSAs are similar to IRAs, but even better:
POS is a Point-of-Service Plan A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge. An indemnity plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any medical provider. You do not need referrals or authorizations; however, some plans may require you to precertify for certain procedures.Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services. Many health insurance companies have moved away from indemnity plans and are instead offering managed care plans such as HMOs and PPOs. You may have few or no indemnity plan choices in your area. A provider is a hospital, healthcare facility, physician or other medical professional that provides healthcare services. A physician or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider. |
