• Health Insurance
  • HMO
  • PPO
  • HSA

Health Insurance

Looking for individual health insurance? You're not alone.

More and more people are realizing they should think about their health before something happens to put it in danger. Whether you are healthy, haven’t seen a doctor in years, or have a medical condition or concerns, no one is immune from the possibility of a catastrophic accident or the diagnosis of a serious medical illness. Routine doctor visits and lab tests may be manageable costs, but hospital stays, operations, and illness treatments generate fees that rapidly soar out of control. By the end of 2007, health care costs are expected to reach 2.25 trillion dollars. How much room is there in your budget for an emergency hospital stay or operation?

In today’s world, even minor surgeries and preventive care easily accrue overwhelming bills. One may ask the question, “But, can I really afford health insurance?” The reality of today’s world is no one can afford not to purchase health insurance. In the event of an accident, injury or illness, medical treatment is not a luxury, it is a necessity.

HMO Plans

A health maintenance organization (HMO) provides “managed care” in return for a monthly or quarterly premium. You pay a fee, the amount depending on the specifics of your coverage, and are offered a range of health benefits that cover the entire spectrum from preventive care and education to physician care, surgery and hospitalization. An HMO is a one-stop shop for all your healthcare needs. Your healthcare is “managed” by your primary care physician, usually a general practitioner.

Typically, you must receive a referral from your physician before visiting a specialist. With rare exceptions, such as when you are away traveling, you are limited to seeking care completely within the network of providers, doctors, hospitals and labs with whom your HMO has negotiated a fee schedule. Since contracting discounts from a network of providers is one of the primary ways a HMO maintains cost effectiveness, the plan only works when you stay within the network. In addition to your premium, an HMO generally charges a co-payment of, for example, $10 or $20 for certain services or prescriptions.

While an HMO is more restrictive than other plans, it can be a convenient and cost effective solution for an insurance consumer that does not have ties to a doctor or medical facility outside of the HMOs network. If the organization is well run, doctor visits and healthcare can be simple, hassle-free and reliable.

PPO Plans

PPO plans are preferred provider plans. Health insurance companies contract a network of doctors and hospitals that are "preferred" by the company. These network doctors and hospitals charge a contracted fee for their services and when you choose to see one of these "preferred providers," the amount you pay out of your pocket is usually quite low. There is typically a small co-payment (a fee per visit or service), which may be $15 or $20. It is important to keep in mind that since the insurance companies keep prices lower by contracting specific doctors and hospitals, there is higher charge for going out of the healthcare provider's network. However, the PPO is a more flexible arrangement than many other plans because the plan will pay some of the costs if you choose to visit a doctor, specialist, or clinic outside the network. For example, if you want to see a world renowned specialist at the John Hopkins Clinic, your PPO plan would reimburse you for at least some of the cost.

Health Savings Accounts

As of January 1, 2004, healthcare consumers have a new way to help manage their own healthcare. Health Savings Accounts (HSAs) provide consumers with added insurance coverage and control. Flexibility is the key component of an HSA. Anyone with a high-deductible health plan can set up a health savings account to save money on medical care now, as well as save for future medical expenses. You may use HSA funds to pay for expenses that must be met before your deductible, to pay for services not covered by your health plan (such as alternative therapies or out-of-network providers), or insurance coverage during periods of unemployment.

Even if you purchase your insurance plan or your health savings account through your employer, you still own your account. You make the decisions on how much to contribute to your account and which medical expenses you will use the funds to pay. When you change jobs or move, the account remains intact. Any unspent balances remain in your account earning interest until you spend them on medical care.

An HSA can be a comforting safety net if you have a high deductible plan (remember, your plan won’t begin paying out until your financial responsibility is met). In the event that you lose a job, must seek uncovered medical services or just want to exercise your right to seek a specialist not contracted with your insurance plan, the funds in an HSA may one day be your saving grace. If you are a consumer who desires security and values freedom, an HSA is an option you should research.

 
 
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