medical insurance plan
Medical Insurance seems to be getting more and more expensive these days. There are 4 basic categories of medical insurance plans from which to choose from.
HMO plan: An HMO plan is the least expensive and most commonly purchased medical insurance plan. Kaiser Permanente established the first HMO in 1930 in an effort to provide employees with medical insurance. An HMO medical insurance plan is the least expensive because it only offers restricted access to health care personel and services, keeping members within a small network through which their care is covered. The policyholder is responsible for payment of any services received outside the network in full, totally removed from the HMO provider. A primary care physician (PCP) is responsible for coordinating HMO health care. This includes:
- Routine & preventive care
- Treatment for illness & injuries
- Referrals to a network specialist or facility when necessary.
POS plan: A POS medical insurance plan is more expensive than an HMO plan, however a POS plan provides its policyholders with more access to health care services. POS policyholders select a primary care physician (PCP) who coordinates their care and makes referrals to other providers within the plan. (You can refer yourself outside the plan & still receive partial health insurance coverage for the services) If your PCP refers you outside of the POS network, the POS will cover all or most of your fees.
PPO plan: A PPO plan is generally more expensive than both POS & HMO plans. PPO plans offer far more flexibility than both and a greater degree of access to health care. You have the option to visit the doctor of your choice, however your costs will be far less if you stay within the PPO network as much as possible. Within the PPO plan medical insurance network, you are required to pay a premium that covers all your healthcare services. Outside of the network, you are responsible for paying a copayment that is based on higher charges. (You will also have to meet the deductible) In some instances, you might also have to pay the difference between the health care fee & the amount that is actually covered through your PPO plan.
Indemnity plan: An Indemnity plan is the most expensive type of medical insurance plan. The upside is that it allows for the most access to healthcare having no network to which the policyholder is tied in any way. Indemnity policyholders have the freedom to go the phsycian of their choosing. Submission of a claim to the medical insurance provider is needed after receiving treatment so you can be reimbursed for the costs. The policyholder's insurance provider will pay for all services designated through your Indemnity plan (Customizable). You can be reimbursed for up to as much as 80% of the health care service costs, & you will be required to pay the other 20% or so. An indemnity plan usually has an "out-of-pocket maximum," which means that after your expenses reach a certain limit in a given year, your insurance provider will then be responsible for 100% of all health care costs.
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