TIPS AND BENIFITE OF INSURANCE
Insuring one’s health is often a complicated matter. It is especially confusing when one’s medical needs fall outside of the standard health insurance plans provided by an employer or through a government program. When these individuals seek out their own health care, they have a variety of options. They can choose from Fee for Service (FFS) plans, which reimburse health providers only for services given. Alternatively, they can get Medicaid, which provides a blanket health insurance benefit to anyone in need, regardless of his or her medical status.
The different types of health insurance to provide coverage for a wide variety of medical conditions and diseases. The two most common types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPO). Both provide significant health insurance benefits to their members, but their differences go beyond the types of services covered. The following paragraphs detail the similarities and differences of HMO and PPO plans.
HMO plans are generally preferred over PPOs because they limit the number of physicians that a member can see through the network. As a member of an HMO, a person is required to visit one primary care physician and to receive medical care under the care plan guidelines approved by the HMO. A PPO, on the other hand, does not require a member to see any primary care physician or to be treated through the PPO’s network. Instead, a PPO allows a health insurance consumer to select a doctor within the network of a participating private health insurer. If the doctor chosen is outside the private insurer’s network, the consumer will be expected to pay the costs of this doctor’s services out-of-pocket.
One major difference between HMO and PPOs is the way in which premiums are paid out. In a PPO, a health service provider (PPO) pays a prearranged monthly premium to an account. When the monthly premium for the plan is reached, the account holder will decide whether or not to renew the account and then pay the balance of the premium in full at the end of the month. Members are not required to pay anything extra for this option. If a member chooses not to renew the account, there will be a prorated amount paid to the health service provider for that month’s services.
Another difference between HMO and PPOs is the manner in which insurance companies base their premiums and co-pays. A PPO policy is more expensive than an HMO policy because it has a lower monthly premium and a lower co-pay. This is because the health care costs at the end of the month are less than they would be for a PPO policy. Also, the co-payments required by HMO policies are higher than those required by PPO policies. A PPO policy can be beneficial to people who do not have the financial resources needed to pay the high monthly premiums required by HMO policies. However, PPO policies are usually more affordable for people who already have a health care plan through their workplace or an individual health care provider.
People who do not already have an insurance plan can obtain one by contacting an insurances company. They will typically require proof of income, ages, and current health conditions. The health insurance company will then determine the lowest cost coverage for the client, depending on the information they provide. Some companies will charge a small co-pay for each visit to the doctor, but some will charge a flat fee for each visit. People who get sick often are better off paying the flat fee to get the maximum level of coverage.
People who are healthy can purchase a policy that will result in them paying a smaller percentage of the total medical care cost. This type of policy is referred to as a “mini-policy.” It will typically result in a lower monthly premium for people who smoke, do not have a family member with a chronic illness, do not utilize their own dental insurance, do not use medical emergencies to avoid paying the deductible, and do not visit doctors on a regular basis. These clients will usually pay a larger share of the total premium for the same coverage. For example, a client who visits his doctor twice a year on average would pay more for this type of coverage than a client who rarely visits the doctor.
Some health care insurance plans will feature deductibles. For people with good health, they are a good way to reduce the monthly premium. The lower deductible will mean that the person paying for the coverage will be required to pay a larger share of the medical costs if he or she gets sick. However, people who are healthy should still attempt to save as much money as possible. A policy with high deductibles typically has a lower monthly premium.