What types of health care plans are available?
What's a fee-for-service plan?
What's an HMO?
What's a PPO?
What's an IPA?
What's a POS health plan?
What's the best health care plan for me?
Do I have to file claim forms if I choose an HMO?
Do I have to file claim forms if I choose a traditional fee-for-service plan?
Will my health care plan pay whatever the doctor charges?
Can I choose any doctor I want in my health care plan?
What's a primary care physician?
What should I look for generally in a health care plan?
What should I look for in a fee-for-service health care plan?
What should I look for in an HMO?
Do all traditional fee-for-service plans provide the same medical coverage?
What's preventive care and is it covered under the health insurance plans?
What's the difference between group and individual insurance?
What's a "free look clause" and how does it protect me?
A: The most common types of health plans are fee-for-service and managed care. There are various types of managed care plans, including:
A fee-for-service health plan is the traditional type of health care policy. Your health insurance company will help pay part of your medical costs. You must pay a deductible before the insurance company will pay anything. You're also responsible for paying monthly fees, called premiums. However, you can usually choose whatever doctor or hospital you want.
HMOs, or Health Maintenance Organizations, are health plans that are prepaid on a monthly basis. You and your family will be provided medical care under the plan. HMOs usually offer lower overall costs compared to fee-for-service insurance. However, you're usually limited to the doctors that have an agreement with your HMO.
A PPO, or Preferred Provider Organization, is a combination of a fee-for-service plan and an HMO. If you want most of your medical costs covered, you're limited in what doctors and hospitals you can choose. However, you can choose a doctor outside of the plan if you're willing to pay more of the medical costs.
An IPA, or Independent Practice Association, is a group of private doctors who provide medical care. The IPA contracts with HMOs to provide medical services to the members. If you're the member of an IPA-type HMO, you can pick one of the participating doctors off the IPA network list.
A POS, or Point-of-Service, plan gives you flexibility in either choosing services in-network or out-of-network. You usually have to pay more money for out-of-network medical services.
Every health care plan has strengths and weaknesses. There's no plan that's best for every situation. What's best for you will depend on your specific situation.
Most HMOs don't require members to file claim forms. You're given a medical card that you give to the doctor or hospital when you need medical care.
You might have to file forms and send them to your insurer to seek payment for medical expenses.
Your insurance plan will normally pay whatever's reasonable and customary for the medical service. It doesn't matter how much the doctor is trying to charge. Many times the doctors and hospitals will accept the reduced fees as paid in full.
You can choose any doctor you want in a traditional fee-for-service plan. However, you normally must pick a doctor in the network in managed care health plans. Some plans, such as PPOs and POS plans, will allow you to choose doctors outside the network, but you might have to pay a larger portion of the medical costs.
Your primary care physician, or PCP, is the main doctor responsible for your medical care. Many health care plans require you to go through your primary care physician for any type of medical service. She'll coordinate your health care and recommend any specialists that you need.
Make sure to find out what each plan will cover in terms of medical costs. You should be aware of any limitations in the coverage. Examine several different types of plans. Compare and contrast the coverage and costs of each plan, and choose the one that best fits your needs.
Examine the monthly premium and the deductible. Do they seem reasonable compared to other plans? Looks at the extent of medical coverage. Does it cover all medical costs or just the basics? Try to determine the maximum amount you would have to pay in a year if there was a major medical emergency.
Since HMOs limit the doctors and hospitals you can use, check to see if you can continue to use your current doctor. Sometimes it can take longer to see a doctor in an HMO plan than a fee-for-service plan. Attempt to find out the ease of making appointments and the length of time it takes to see the doctor. Ask how much the HMO plan will cost you for the year.
Your fee-for-service plan may offer basic medical coverage, major medical coverage or both. Basic coverage pays the lower, short-term medical costs, such as hospital rooms and x-rays. Major medical covers the high cost of a serious injury or a long-term illness. Look for a plan that offers both to fully protect yourself.
Preventive care focuses on maintaining good health and detecting any medical problems early. Many health care plans cover preventative care, such as immunizations, routine physicals and mammograms.
Most people have group insurance through work. This insurance can usually be offered at a lower rate since it covers a large number of people. Individual insurance is usually for those people who can't get insurance through work and have to enter into a health insurance plan individually.
Yes, although you're usually limited to 100 percent of your medical claim in total.
Many insurance policies will contain free look clauses. This means that you can look the policy over when you receive it and cancel without penalty for a certain number of days. The clause protects you if you believe that the policy isn't what you want or doesn't suit you.