Health Insurance Options

 

Health Insurance Options - How to Find a Plan That Fits Your Needs and Budget

When you're shopping for health insurance, you need to consider a variety of factors, including your budget and provider network. You can also select from HMOs and PPOs, which offer a wide network of participating providers. Critical illness policies don't pay all of your bill and point-of-service plans come with lower out-of-pocket costs. Here's how to find a plan that fits your needs and budget.

HMOs limit your choice of providers

Most HMOs limit the choice of providers to the network of doctors they approve. They will cover most of your medical costs, after you pay a deductible and copay. However, you are limited to the network of doctors and hospitals they approve, and you must check with your plan before using an out-of-network doctor. Also, unless your insurance company approves your doctor, you may have to pay out-of-pocket for services you receive outside the network.

Most HMOs require you to choose a primary care physician (PCP) when you join the plan. This physician will be the primary point of contact for your medical care and will coordinate any additional care you need. In some cases, you may need to see a specialist, but if your PCP is a network doctor, you can see a specialist without a referral. However, if you have a medical emergency, your primary care doctor is often your best option.

PPOs offer a large network of participating providers

PPOs are organizations that contract with a large number of medical providers. They vary in their processes for processing claims, assuring financial risk, and marketing to employers. Some are owned by large insurance companies, while others are smaller organizations that focus on developing provider contracts and third-party administrator services. PPOs provide health insurance coverage through contracts with participating providers, and the use of their network is often referred to as "renting the network."

The PPO disenrollment rate is similar to that of competing CCPs, although slightly higher than that of recent enrollees. This indicates that enrollees were either not fully aware of the PPO option or were unsatisfied with it. The PPO disenrollment rate was 12.3 percent for the January 2003 to June 2004 period and 13.1 percent for competing CCP enrollees.

Critical illness policies don't cover most of your bill

Most major medical health insurance plans have deductibles that must be met, and will only cover between 60 and 80 percent of a procedure's cost. That means that a $20,000 procedure could cost you as much as $4,800 or $4,000 after deductible. Critical illness insurance is an excellent choice for filling in these gaps. It pays a lump sum amount in the event of a covered illness.

The benefits of critical illness insurance can include more than medical bills. These policies may help pay for out-of-pocket expenses related to the diagnosis, such as retrofitting a car with a lift or a wheelchair. They can also cover other living expenses, such as car payments or child care. But be careful: critical illness insurance does not cover most of the bill. If you do need to use your money for non-medical expenses, you might have to use your coverage to help pay off your mortgage, rent, or car payments.

Point-of-service plans offer lower out-of-pocket costs

Point-of-service (POS) plans can be used to see doctors and specialists outside the insurance company's network. In such situations, the patient will pay a higher out-of-pocket deductible and will face a higher copay. POS plans are cheaper than PPOs and HMOs, but they offer a lower out-of-pocket limit and may not be suitable for everyone.

Unlike PPOs and HMOs, point-of-service plans are not as widespread as those of HMOs. As of 2021, only 9% of covered workers would have employer-sponsored plans. However, those who opt to purchase coverage on their own can choose between HMOs, PPOs, or EPOs. As such, they can save money while maintaining quality medical coverage.

A POS plan has different out-of-pocket costs based on which provider you use. However, there are drawbacks as well. For example, in a POS plan, members must fill out forms when they go to a doctor who is not in their network. Additionally, the insurance company will pay a lower percentage of out-of-network charges than it would for HMOs.