Whether you're buying individual or group health insurance, there
point of service (POS) plans and preferred provider organizations
(PPOs).
Each plan has its own features to consider before making your choice.
HMOs, PPOs and POS plans fall under the umbrella of "managed care"
plans, which emphasize cost-effective medical care.
FFS, also called traditional indemnity
FFS coverage offers flexibility in exchange for higher out-of-pocket
expenses, more paperwork and higher premiums.
FFS advantages
You may choose your own doctors and hospitals. There are no
networks. You may visit any specialist without getting permission from a
primary care physician (PCP).
Most FFS plans have a cap, which is the most you will have to pay for
medical bills in any one year. You reach your cap when all your out-of-
pocket expenses (deductibles and co-insurance) total a certain amount.
The insurance company then pays 100 percent for anything covered
under your policy. The cap amount doesn't include your premium.
FFS disadvantages
There's typically a deductible (anywhere from $500 to $1,500) before
the insurance company starts paying claims, and then doctors are
reimbursed 80 percent of the bill while you pick up the remaining 20
percent. You portion is called co-insurance.
You might have to pay up-front for medical services and then submit the
bills for reimbursement. To receive payment you have to fill out forms
and send them to your insurer, or find a doctor who will do this for you.
You also need to keep receipts for drugs and other medical costs.
FFS plans pay for "reasonable and customary" medical expenses. If your
doctor charges more than the average for your area, you will have to
pay the difference.
Not all health expenses you have count toward your deductible. Only
services covered by the policy.
HMOs
HMOs are often the least expensive in premiums but also the least
flexible of all the health insurance plans. A major objective of an HMO is
to reduce medical care expenses by increasing the use of preventive
health services. HMOs are designed to maintain the individual’s health as
well as provide adequate medical care when an illness or injury occurs.
HMO advantages
They offer low co-payments, minimal paperwork and coverage for many
preventive-care and health-improvement programs.
Usually you have a wide selection of physicians and hospitals on HMO
plans.
Participants pay a small fee (or a co-payment) of usually $15 to $20 for
each visit to a physician in the HMO network.
Basic health services with an HMO typically include physician services,
outpatient services, medical treatment, short-term mental health services
and outpatient/inpatient emergency room visits.
HMO disadvantages
You must choose a primary care physician (PCP).
If your physician is not on the plan, you will have to obtain special
permission and pay a higher proportion of the cost of the office visit or
you will have to pay for the entire treatment from that physician.
HMOs require you to see network doctors, or you'll have to pay most of
the bill or all of it.
The HMO directly and indirectly controls the amount of health care that
the doctor is allowed to provide to you.
You must get a referral from your PCP to see a specialist.
If you require lab work and don't use a lab physician in the network, you
will not be reimbursed for lab work.
If your regular physician drops out of the HMO plan, you must look for
another physician that is in the plan, or pay a higher cost for using the
same physician.
POS plans
POS plans are more flexible than HMOs, but they also require you to
select a primary care physician. A POS plan combines the care aspect
of an HMO with the freedom-of-choice of traditional medical insurance.
HMOs might offer A POS can also be out of network benefits offered by
an HMO.
The POS plan arranges a network of health care providers who will treat
plan participants for a small fee or co-payment, but at the time of an
illness or injury, the patient may choose to visit a doctor outside the
network. You then seek reimbursement from the POS plan.
POS advantages
Depending on your insurance company's rules, you may choose to visit a
doctor outside the network and still receive coverage — but the amount
covered will be substantially less than if you go to a physician within the
plan's network.
POS plans tend to offer more preventive care and well-being services,
such as workshops on smoking cessation and discounts to health clubs.
POS disadvantages
You must choose a PCP.
PPO plans
PPOs give policyholders a financial incentive — reasonable co-payments
(also called co-pays) — to stay within the group's network of
practitioners.
PPO advantages
The standard co-payment is $10 for a routine office visit during regular
hours.
You may go to any specialist without permission, as long as the doctor
participates in the network.
PPO disadvantages
If you see an out-of-network doctor, you might have to pay the entire bill
yourself and then submit it for reimbursement.
The PPO deductible is often the highest among small to midsize
employers and rising. The median deductible for individual coverage for
PPO plans was $1,000 in 2008, up from $500 in 2007 and $250 in 2000,
according a national survey of health plans by Mercer, a human
resources consulting firm.
You might have to pay a deductible if you choose to go outside the
network, or pay the difference between what network doctors and out-of-
network doctors charge.
PPO plans may charge you higher co-payments than what is specified
on the plan if the physician charges more than what is considered
“reasonable and customary.”
How to find an individual health plan
Your first step in researching health coverage is look at coverage options
and price quotes online or to contact A-Advantage Insurance. You should
discuss with your agent your own particular health insurance needs.
Think carefully about what coverage you must have. Is your doctor in the
network? How much will you pay out of pocket for a routine check-up?
How much could you pay out-of-pocket if you have a hospitalization? Are
well-child visits included? Do you need prescription drug coverage? What
about dental coverage too?
point of service (POS) plans and preferred provider organizations
(PPOs).
Each plan has its own features to consider before making your choice.
HMOs, PPOs and POS plans fall under the umbrella of "managed care"
plans, which emphasize cost-effective medical care.
FFS, also called traditional indemnity
FFS coverage offers flexibility in exchange for higher out-of-pocket
expenses, more paperwork and higher premiums.
FFS advantages
You may choose your own doctors and hospitals. There are no
networks. You may visit any specialist without getting permission from a
primary care physician (PCP).
Most FFS plans have a cap, which is the most you will have to pay for
medical bills in any one year. You reach your cap when all your out-of-
pocket expenses (deductibles and co-insurance) total a certain amount.
The insurance company then pays 100 percent for anything covered
under your policy. The cap amount doesn't include your premium.
FFS disadvantages
There's typically a deductible (anywhere from $500 to $1,500) before
the insurance company starts paying claims, and then doctors are
reimbursed 80 percent of the bill while you pick up the remaining 20
percent. You portion is called co-insurance.
You might have to pay up-front for medical services and then submit the
bills for reimbursement. To receive payment you have to fill out forms
and send them to your insurer, or find a doctor who will do this for you.
You also need to keep receipts for drugs and other medical costs.
FFS plans pay for "reasonable and customary" medical expenses. If your
doctor charges more than the average for your area, you will have to
pay the difference.
Not all health expenses you have count toward your deductible. Only
services covered by the policy.
HMOs
HMOs are often the least expensive in premiums but also the least
flexible of all the health insurance plans. A major objective of an HMO is
to reduce medical care expenses by increasing the use of preventive
health services. HMOs are designed to maintain the individual’s health as
well as provide adequate medical care when an illness or injury occurs.
HMO advantages
They offer low co-payments, minimal paperwork and coverage for many
preventive-care and health-improvement programs.
Usually you have a wide selection of physicians and hospitals on HMO
plans.
Participants pay a small fee (or a co-payment) of usually $15 to $20 for
each visit to a physician in the HMO network.
Basic health services with an HMO typically include physician services,
outpatient services, medical treatment, short-term mental health services
and outpatient/inpatient emergency room visits.
HMO disadvantages
You must choose a primary care physician (PCP).
If your physician is not on the plan, you will have to obtain special
permission and pay a higher proportion of the cost of the office visit or
you will have to pay for the entire treatment from that physician.
HMOs require you to see network doctors, or you'll have to pay most of
the bill or all of it.
The HMO directly and indirectly controls the amount of health care that
the doctor is allowed to provide to you.
You must get a referral from your PCP to see a specialist.
If you require lab work and don't use a lab physician in the network, you
will not be reimbursed for lab work.
If your regular physician drops out of the HMO plan, you must look for
another physician that is in the plan, or pay a higher cost for using the
same physician.
POS plans
POS plans are more flexible than HMOs, but they also require you to
select a primary care physician. A POS plan combines the care aspect
of an HMO with the freedom-of-choice of traditional medical insurance.
HMOs might offer A POS can also be out of network benefits offered by
an HMO.
The POS plan arranges a network of health care providers who will treat
plan participants for a small fee or co-payment, but at the time of an
illness or injury, the patient may choose to visit a doctor outside the
network. You then seek reimbursement from the POS plan.
POS advantages
Depending on your insurance company's rules, you may choose to visit a
doctor outside the network and still receive coverage — but the amount
covered will be substantially less than if you go to a physician within the
plan's network.
POS plans tend to offer more preventive care and well-being services,
such as workshops on smoking cessation and discounts to health clubs.
POS disadvantages
You must choose a PCP.
PPO plans
PPOs give policyholders a financial incentive — reasonable co-payments
(also called co-pays) — to stay within the group's network of
practitioners.
PPO advantages
The standard co-payment is $10 for a routine office visit during regular
hours.
You may go to any specialist without permission, as long as the doctor
participates in the network.
PPO disadvantages
If you see an out-of-network doctor, you might have to pay the entire bill
yourself and then submit it for reimbursement.
The PPO deductible is often the highest among small to midsize
employers and rising. The median deductible for individual coverage for
PPO plans was $1,000 in 2008, up from $500 in 2007 and $250 in 2000,
according a national survey of health plans by Mercer, a human
resources consulting firm.
You might have to pay a deductible if you choose to go outside the
network, or pay the difference between what network doctors and out-of-
network doctors charge.
PPO plans may charge you higher co-payments than what is specified
on the plan if the physician charges more than what is considered
“reasonable and customary.”
How to find an individual health plan
Your first step in researching health coverage is look at coverage options
and price quotes online or to contact A-Advantage Insurance. You should
discuss with your agent your own particular health insurance needs.
Think carefully about what coverage you must have. Is your doctor in the
network? How much will you pay out of pocket for a routine check-up?
How much could you pay out-of-pocket if you have a hospitalization? Are
well-child visits included? Do you need prescription drug coverage? What
about dental coverage too?
| Your Local Agent for Auto Life Health Business Home Liability Dave Pellicano 772-879-1669 |
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