Finance Tips

When it comes to insuring ones health there’s no denying the fact that this form of insurance is a must for everyone even though it’s not legally required and is purely optional. It’s hard to imagine the current healthcare system without insurance because otherwise people couldn’t afford most medical services and doctors wouldn’t get their high salaries, which are among the highest all over the world. Thanks to insurance both customers and service providers are pleased, and everyone’s getting the thing they want. Among many types of insurance available managed care plans are the most widespread, so let’s take a closer look at some of the most common forms of insurance offered by insurers:

Health Maintenance Organizations (HMO)

This is the most common form of managed care plans as it provides the lowest price and a wide range of services included. It’s main drawback is the lack of flexibility in what concerns the places you get care from. Under HMOs you are limited to a network of facilities and specialists you may get care from and covered to the full extent. If you choose to get your services from someone outside the network your costs won’t be covered at all. Moreover, you are required to choose a primary care physician who will refer you to all the required specialists, so there’s more paperwork involved with this type of plans. Yet, you usually pay lower premiums for that so it’s really worth the effort.

Preferred Provider Organizations (PPO)

Preferred Provider Organizations offer more flexibility but for a higher price if compared to HMO plans. You are still limited to a network of providers to get care from, however if you choose to go out of network there will still be some part of your bill covered only to a lesser extent compared to in-network services. And you aren’t obliged to choose a primary care physician so there’s not so many office visits to do under this type of managed care plans. If you have the additional money and want more flexibility with your health insurance this plan type will definitely appeal to you.

Point Of Service (POS)

Point Of Service plans are often referred to as a mix of HMO and PPO plans as they provide the benefits of both these forms of health insurance. You gain the flexibility of PPO in what concerns the places you get services at, yet you still have to choose a primary care physician and have a network of providers to work with. One of the greatest benefits is that you may choose your family doctor as a primary care physician even if he or she doesn’t make part of the insurer specified network, which is definitely appealing to those who have long term relations with their family doctors. PPO plans may vary in price so it’s really recommended to shop around if you want to get the best rate possible.

As you see, managed care plans come in different forms with the sole purpose of giving you exactly what you need. So it’s really important to assess your individual health insurance needs before choosing the plan type to address them adequately.

Got questions about health insurance? Here are the top 10 health insurance questions and answers:

1. What kinds of health insurance plans are there?

There are two basic types of health insurance plans – indemnity plans and managed health care plans. Indemnity plans let you choose your own physician, while managed health care plans – HMOs, PPOs, and POSs – assign you to a network of physicians and hospitals. Managed health care plans are less flexible, but much cheaper than indemnity plans.

2. What’s an HMO?

With an HMO you pay a monthly premium for which you are assigned to a network of physicians, specialists, and hospitals who provide your medical care. A primary care physician oversees your care and you can only see physicians within your network. Prescriptions may completely covered or partially covered and generally require a co-payment of $5 to $10. This is the cheapest type of health insurance.

3. What’s a PPO?

A PPO is similar to an HMO, but it allows you to visit non-network physicians without a referral from your primary care physician. You may have to pay for the non-network physicians fee, then get partial reimbursement from your PPO provider. Co-payments are generally $5 to $10, and this plan costs a little more than an HMO.

4. What’s a POS?

A POS plan is a combination of an HMO and a POS plan. You choose a primary care physician within your network, but you can also see physicians outside the network. If your primary care physician refers you to an outside physician your POS provider picks up the costs. This is the most flexible and the most costly of the three managed health care plans.

5. What is a deductible?

A deductible is the amount you pay toward a claim before the insurance company pays.

6. What’s coinsurance?

Coinsurance is the percentage of your medical expenses you have to pay after you pay your deductible.

7. What is a co-payment?

A co-payment is the amount you must pay when you visit a physician.

8. How do I choose a health insurance plan?

Ideally, you want to choose a plan that will give you the most amount of benefits for the least amount of money. If you want to continue seeing your current physician, find out what plans he or she is associated with. And if you have special medical needs, make sure the plan you choose will provide for those needs.

Other things to consider when choosing a health insurance plan are:

* What are the co-payments, deductibles, and coinsurances?

* Does the plan cover pre-existing conditions?

* What is the waiting period for pre-existing conditions?

* Will the insurance company give me good service?

9. Where can I get cheap health insurance?

Insurance premiums vary substantially from one company to another, so you want to get quotes from several companies in order to get the best price.

The quickest way to get quotes from different companies is to go to an insurance comparison website. Once there you’ll fill out a short questionnaire, then receive your quotes. The best comparison sites only deal with A-rated insurance companies so you know you’ll be getting a reputable company. They also have an insurance expert on call to answer your questions. (See link below.)

10. How do I know I’m getting a reliable health insurance company?

One of the best places to check out an insurance company is your state’s department of insurance website. You can also visit J.D. Power & Associate’s website (jdpower.com) to get consumer ratings on insurance companies, and A.M. Best’s website (ambest.com) to get financial ratings.