Getting the Best Health Insurance
Navigating the health care system can be a tricky task. Although there are many private health insurance plans for sale, they don’t all provide the same level of protection. Most people will look at the price of coverage first and not the comprehensiveness of the plan. It is best to consider both price and comprehensiveness to determine the value of the plan. Often, there is a direct tradeoff between the level of protection a plan provides and the cost of the plan. When weighing the tradeoffs, keep in mind that purchasing inadequate coverage is risky.
To evaluate the adequacy of a health plan, carefully read the list of services and benefits that are covered before choosing one. Many online websites for insurance provide worksheets that can be printed out for a health insurance comparison. Take advantage of these worksheets to keep your analysis of each plan organized. To begin, evaluate the following basics of the policy:
-Hospital and physician care
-Lab tests
-Prescription drugs
-Medical equipment
-Rehabilitation services
-Mental health care
Fee-For-Service Insurance Plan
Traditionally known as indemnity coverage, today’s fee-for-service coverage offers a wide range of autonomy when choosing doctors or hospitals. You can also select your own specialist without first getting permission from your provider. In addition, the insurance company does not have a say as to whether or not the visit was necessary. These pros make the plan very attractive, however, there some disadvantages. With a fee-for-service plan, you will incur more out-of-pocket expenses, and the deductibles are usually higher. Deductibles range from $200-$2500 before the provider begins paying. Once the deductible is met, the provider will pay approximately 80 percent of the doctor bills. Even though you have autonomy when choosing doctors, fee-for-service providers will only pay for what they deem customary and reasonable doctor expenses. If your doctor charges more than what the provider feels is customary, you will probably have to pay the difference. In sum, fee-for-service coverage offers you flexibility with greater out-of-pocket expenses.
Preferred Provider Organization Insurance Plan
Preferred provider organization insurance plans fall under managed care providers. With a network of health care providers, PPOs are able to negotiate lower fees. PPOs also provide their clients with a financial incentive to use the doctors within the network. When using a doctor within the network, you will only pay the established co-pay. Should you decide to see a doctor outside of the network, you will have to pay upfront and then submit the bill to the provider for 80 percent reimbursement. You may even have to pay the difference between what the out-of-network doctor charges and what the in-network doctor charges. As long as you choose a doctor within the network, you can also select a specialist without prior approval under a PPO plan. Needless to say, using doctors within the network is financially advantageous.
Health Maintenance Organization Plans
Similar to PPOs, health maintenance organization plans have an arrangement between a selected network of health care providers and the insurer. Policyholders have significant financial incentives when they use the health care providers in the approved network. In general, HMOs are the least expensive insurance plans and the least flexible. HMOs have low co-payments, low premiums and a minimal amount of paperwork. On the downside, HMOs have strict procedures that must be followed. It is required that you only see doctors in its approved network. Unlike a PPO, you may not see doctors outside of the network and file for reimbursement. Before you see a specialist, you will need to get a referral from the primary care physician.
In sum, take the time to review health insurance plans carefully and always consider the comprehensiveness of the plan. Your health plan is the ticket to good health care.
