Types of HealthCare Plans

Deciding on the right insurance company and plan to meet your needs can seem overwhelming. You will probably be tempted to take the program with probably the lowest out of pocket expenses. Nevertheless, selecting the best health plan for you requires looking at different factors, not only one number. If you’re approaching age 65 or helping someone who is, see our Medicare Guide for details on Medicare enrollment and coverage.

What’s an HMO?

A health maintenance organization, or perhaps HMO, is a kind of group health insurance plan. An HMO is a managed care plan which requires you to select a primary care physician from the plan’s list of contracted providers.

Is an HMO the right program for me?

Before you decide to run out and register for an HMO, please keep the following pros and cons in mind. No need to file a claim form for office visits or perhaps hospital stays. HMOs focus on preventative medicine and may provide access to specialists or perhaps programs that’ll enable you to develop healthier habits. With most HMOs, you have to stay in your network of medical facilities and doctors or perhaps risk having to pay the full charge yourself. You might have to wait longer for an appointment than you’d with some other types of insurance. You might also discover that your time spent with your healthcare provider is strictly limited. You’ll most likely make a small copayment for every office visit. It is usually not easy to have specialized care and costly if you go outside the network for that care situation covered as emergency care is strictly limited. Due to all of the rules and expectations for providers, there might be a high turnover rate.

What exactly are the advantages and disadvantages of selecting a PPO?

Here are several of the advantages. The healthcare costs of yours are generally reasonably low when using providers within the PPO network. Unlike with an HMO, you can consult some doctor or specialist, including outside the plan, without preauthorization. You don’t have to see a primary care physician before scheduling a scheduled appointment with a specialist. You do not need preauthorization or referrals for visiting a healthcare provider who’s in the network.

The disadvantages

In case you’re outside the network, you will have to file claims with the insurance company and deal with whatever paperwork is needed to substantiate the need for therapy. If you go out of the network, such as to see a provider you prefer, your costs will be much more expensive. Your copayments for office visits are usually higher than you will see with an HMO.

• Are the doctors, hospitals, and other healthcare providers you are already using in the network, or would you have to pay out-of-network expenses?
• Are the hospital’s doctors and offices conveniently located in the network, or would you have to travel far?
• Do you need preauthorization or referrals to see specialists?
• Does the plan limit payment for emergency care?
• What specific healthcare services are covered?
• Are preventive services covered?
• What are the boundaries on treatments?
• What’s the monthly premium? Annual out-of-pocket limit?
• What are the copayments for specific services?
• What’s the cost of using network providers?

Exclusive Provider Organizations (EPO)

An EPO, like an HMO, has a network of contracted healthcare providers. You do not have to name a primary care physician or obtain a referral to see a network provider. This combines cost-effectiveness with provider contracting to offer services at agreed reimbursement levels. Among the positives of a PPO is not needing referrals to see a specialist.

Point of Service (POS) Plans

A POS plan is a managed care plan that includes elements of both HMOs and PPOs. Like an HMO, you usually pick a primary care physician responsible for your basic care and need referrals for specialists. Nevertheless, the plan reimburses for visits to providers outside your network.

High Deductible Health Plans

With few exceptions, none of your medical costs are met until after you have paid the full deductible out of pocket.

Health Savings Accounts (HSA)

Used with high deductible plans, you contribute a portion of your pretax income to an HSA and use it to pay unreimbursed medical expenses.

Flexible Spending Accounts (FSA)

Much like an HSA, an FSA allows you to use pretax dollars to pay for unreimbursed medical expenses.

This Medicare resource was provided by Amerus Insurance Group, a trusted source for individual and family health insurance solutions nationwide. We help clients compare ACA marketplace plans, private health coverage, and supplemental options to find the right balance of benefits and affordability. Contact Amerus today for a free health plan review.