When it comes right down to the nitty-gritty of what health insurance to get that will best cover you and your loved ones, it’s not always as easy as “grab-and-go.” What all should be covered? How can you know which “what if” you to be prepared for? How can you possibly figure out every single possibility or probability?
On your journey to figure it all out, let’s start off with a general description of the basic types of health insurance.
Health Insurance via a Health Maintenance Organization (HMO)
First up, we have Health Maintenance Organizations (HMOs). You’ve most likely heard of these whether just in passing, or perhaps as a choice with an employer’s plan. These are medical insurance groups that provide health services for a fixed annual fee. Each provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, and act as the liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. We know that’s quite the mouthful! If you’ve worked for—or have—a company with 25 or more employees, this federally-certified HMO option is required to be offered, if the employer offers traditional healthcare options. An HMO covers care given by those doctors and other professionals who have agreed by contract to treat patients under the HMO’s guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider’s contracted status.
Fee for Service Health Insurance
Next up, we have what’s called fee-for-service, and is precisely as its name says—services are unbundled and paid for separately. It gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care rather than the quality. In doing so, it can raise costs enormously. This fee-for-service method is the dominant physician payment method in the United States.
Health Insurance via a Preferred Provider Organization (PPO)
Moving on, there are also PPOs, or Preferred Provider Organizations. This is more or less what’s known as an “in-between” option. They are managed care organizations of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates.
Point of Service Health Insurance
Lastly, Point of Service is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, you may designate an in-network physician to be your primary care provider; but like a PPO, you may go outside of the provider network for health care services. It’s important to keep in mind that if you venture out of the network, you’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider. The medical plan then covers the cost.
Remember, no matter what health insurance you have, coverage will always depend on the type of plan, deductibles, provider network, etc. Basically, typical health insurance plans won’t cover everything, such as dental and vision which are usually under separate plans.
What is the Health Insurance Marketplace?
You may have heard about the Health Insurance Marketplace, a service that helps people shop for and enroll in affordable health insurance. The federal government operates the Marketplace, which is available at HealthCare.gov, for most states. Some run their own Marketplaces; but all provide health plan shopping and enrollment services by using and offering websites and links, call centers, and even in-person help.
If you’re an individual or family, you provide necessary information that then lets you know if you qualify for premium tax credits or other savings, or coverage through Medicaid or your state’s Children’s Health Insurance Program (CHIP). If your state runs its own Marketplace, the information you provide (state or zip code) will redirect you automatically.
However, if you have the option, we recommend working with a trusted, local insurance agency for all of your personal and business health insurance needs. That’s why we at M&P Insurance work hard to provide all the standard health insurance plan types, including individual health insurance, group health insurance, medicare insurance, dental insurance, vision insurance, and more.
How to Choose the Right Health Insurance Plan for Your Needs
When it comes right down to it, here are a few things to keep in mind when deciding what’s right for you and your personal individual situation.
- View your plan options side-by-side.
- Decide whether an HMO, PPO, EPO or POS is best for you and your family both in terms of service and financially. Do you want an HSA-eligible plan?
- Eliminate plans that would exclude your present doctor and/or any local doctors in the provider network.
- Decide if more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs, is best for you.
- Ensure that whatever you choose will pay for your regular and necessary care, like prescriptions and specialists.
Once you’ve thought about all that, then make your final and best decision by letting us put our knowledge and expertise to work for you in making sure you are properly covered at the best price for your budget and situation. Call us at (870) 523-6771 or come on by our offices for a chat at 105 Laurel Street in Newport.
