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Welcome To Health Insurance 101.
Health insurance basics.
At some point in everyone’s life they are going to get sick and may need to visit the doctor. Do you have the right type of health coverage in place to make your doctor visit as affordable as possible? You have probably heard of HMO, PPO and POS. Do you know the differences between them? There are two main groups of health insurance. Traditional health care and managed health care.
Health insurance types.
Traditional health plans, also known as “fee for service” plans, allow the insured to visit any physician of their choosing. This type of insurance plan will have higher co-pays and deductibles. Your co-pays and deductibles are what you would pay out of pocket prior to the insurance company paying a portion or all of the doctor bill. In a fee for service plan, the insurance company may have you pay the entire bill then submit to them for reimbursement. It is different with each insurer. The most popular plans today are under the managed health care category. Managed
plans involve the use of a network of health care providers. This network is set up so insurance companies can drive business to selected doctors. This agreement between insurance companies and health care providers allows for lower health care costs for the insurer and the insured.
Health Maintenance Organization, also known as “HMO”, will have a set group of network providers. The HMO generally requires the insured to choose one primary care physician within that network. If a specialist was ever needed, a visit to the in-network primary care physician would be made and they would refer the insured to the specialist. If an out-of-network provider was ever used with HMO, the insurer will usually not cover any expenses. Within the managed health care group, HMO will generally cost the least as long as you stay within the plans' network.
Preferred Provider Organization, or “PPO”, is similar to HMO in that you use a network of providers. The PPO offers more flexibility. With a PPO you do not have to see a primary care physician before you see a specialist. You can see any doctor of your choosing as long as they are within the network. If you go out of the network, the insurer may pay a percentage of the medical bill. Before visiting a health care provider outside of the plans' network, it is recommended that you always contact insurance companies prior to the visit to determine what they will pay, if anything. This is true with any plan. The flexibility of a PPO will usually come with a higher cost.
Point-Of-Service plan, or a “POS”, is similar to both a HMO and a PPO. With a POS plan you will choose a specific primary care physician within a network of providers. This primary care physician also known as your "point-of-service" can refer you to an in-network or out-of-network specialist if ever needed. If you are referred out-of-network, then the insurance may pay part of the claim but usually not as much as an in-network specialist.
Preferred Provider Organization, or “PPO”, is similar to HMO in that you use a network of providers. The PPO offers more flexibility. With a PPO you do not have to see a primary care physician before you see a specialist. You can see any doctor of your choosing as long as they are within the network. If you go out of the network, the insurer may pay a percentage of the medical bill. Before visiting a health care provider outside of the plans' network, it is recommended that you always contact insurance companies prior to the visit to determine what they will pay, if anything. This is true with any plan. The flexibility of a PPO will usually come with a higher cost.
Point-Of-Service plan, or a “POS”, is similar to both a HMO and a PPO. With a POS plan you will choose a specific primary care physician within a network of providers. This primary care physician also known as your "point-of-service" can refer you to an in-network or out-of-network specialist if ever needed. If you are referred out-of-network, then the insurance may pay part of the claim but usually not as much as an in-network specialist.
Summary.
Every person's needs are going to be different. If you know the different health insurance options available, you can make an informed decision on what will work best for you. If you are someone that does not visit the doctor often and likes the flexibilty of seeing any health care provider you choose, then a traditional plan or "fee-for-service" plan may be best. If cost is important, then a managed health plan may be better. Sometimes having the coverage we need can be costly. Most likely, more than we initially had in mind to spend. QuoteClicker's goal is to be able to assist our customers in getting muliple quotes from the nations' leading insurance providers. This is a service we offer for FREE to our customers in search for insurance. By having multiple quotes, you are able to evaluate all of them and make sure that you are not only getting the proper amount of coverage for you and your family, but also making it affordable at the same time.
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