Are you in need of medical insurance? Shopping for a health care plan can be quite intimidating since the choices endless and every coverage is different. How does one make sense of the myriad of choices facing them when searching for a health care plan? For many people in the United States, a health care plan is chosen for them by their employer. In this case, individuals covered by their employer’s health care plan still need to understand the coverage and the protection it provides.
Health care plans have changed in the United States over the past fifty years. It used to be that most American’s were covered by indemnity insurance which allowed patients to seek out treatment by any medical provider, with the insurance company being billed for part of the cost. Now health care plans offer Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and point-of-service plans (POS). It is important to be informed of the differences between these health care plans when choosing one that is a proper fit for you since one plan may be a better fit than another. If your health care plan is administered by your employer, your employee benefits office is the place to start in finding out more about your health care plan.
Health care plans are divided into two groups: indemnity (pay per service) and managed care. Each health care plan requires a different premium, which is the amount you pay every month to be covered by the health care plan. The differences in these plans include choice of providers and expenses for services covered. Managed health care plans (HMOs, PPOs, and Poss.”) provide patients with specific doctors, hospitals, and clinics that will offer health care services at reduced costs. Meanwhile, most indemnity plans allow patients to chose their own health care provider and the indemnity insurance company then pays a percentage of the cost after being billed. The standard cost split for health care services on an indemnity health care plan is 20/80, with the health care plan paying eighty-percent of the cost. It is important to study the specific differences in certain health care plan coverage, as the indemnity and managed care providers have begun to compete for enrollment by offering similar protection.
HMOs are the oldest form of managed health care plans and its medical providers can be contracted out by the health care plan or be a direct employee. For a monthly fee, patients receive preventative care, including check-ups. Most preventative services are offered at a small co- payment fee of five to fifteen dollars. HMOs provide patients with a list of doctors to choose from as a primary care physician, with special needs being referred out. If a patient chooses to see a doctor that is not included on the HMOs coverage list, the patient will bear the total cost. PPOs closely resemble indemnity health care plans in that the patient does receive coverage if being seen by a doctor outside of the health care plan network. However, patients may have to meet the deductible and pay higher fees in this case.
This is just a start to the information available on health care plans in the United States. If you are seeking a health care plan and are in need of medical coverage, there is much more education available as to the unlimited choices you possess.