Considering the fact that nearly one out of six Americans has no health insurance, it's fair to say that this country is in the midst of a health care crisis. Despite the efforts (or lack thereof) of local and federal politicians, over 40 million people in this country have no type of health coverage. These statistics may seem surprising to some, but for the millions who struggle to pay health care bills for themselves and their families, they are an inescapable reality.
Managed Health Insurance
:
As health care costs have increased over the years, health insurance companies have developed new types of policies and coverages aimed at keeping prices down for everyone involved. These are typically referred to as "managed care" coverage. Among the many types of managed care coverage are PPOs, POS, and HMOs.
PPO stands for Preferred Provider Organizations. This type of coverage involves a network of health care providers that have negotiated their rates with the insurer. When in need of care, you simply go to any physician in the PPO's network. If you stay within the network, your only out-of-pocket expense is a small co-pay. If you go to a provider outside of the network, your PPO coverage will pay only a percentage of the total bill.
HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your Primary Care Physician.
A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan's network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits. Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you'll likely have to pay up-front and submit a claim to the insurance company yourself.
The best health insurance plan depends on the following :-
- Are you going to need long-term coverage or just something for the short-term ?
- Are you looking for basic coverage or more comprehensive coverage ?
- Would you rather pay for your services before you use them or when you use them ?
- How important to you is easy access to specialists ?
- Do you have a specific doctor or hospital that you would like to visit for healthcare ?
- What is the most you could pay out in case of a serious illness or injury ?
Health insurance is essential for ensuring your families good health and safety unless you are independently wealthy you should have health insurance; at the very least "Catastrophic Health Insurance".
Check this guide for information on the benefits of these health plans for you!
