Health Insurance Plans

Types of available health insurance plans

The basic categories of health insurance plans available in the market are:

  • Fee-for-Service plans
  • Health Maintenance Organizations (HMO)
  • Point-of-Service plans (POS)
  • Preferred Provider Organizations (PPO)

Fee-for-Service plans

The plans are very traditional and work in a very simple manner. Under this, the company offering insurance pays health expenses of the insured person at the time of need and the insured person requires paying only some part of the expenses.

The insured person pays a certain amount of premium to the insurance company on monthly basis to avail the health care facilities. The plan allows the insured person to select any hospital or doctor of his/her choice to get health care services at the time of need.

The insured person needs to pay certain amount of deductibles every year to share portion of health expenses as 'coinsurance' with the insurance company.

The plan offers basic and major medical protection coverage's. Here, basic coverage covers the expenses of basic health care services like hospital room services, x-rays, bills of medicines. Whereas, major medical protection covers medical expenses of major diseases and injuries, with this it also covers left over of basic medical protection coverage.

A person who is interested in buying this plan should ask some questions regarding the amount of monthly premium, the expenses covered under the policy, amount of deductibles, or coinsurance rate to his insurance agent before enrolling for it.

Health Maintenance Organizations (HMO)

In this, the insured person or the Health Maintenance Organizations (HMO) member pays for the coverage in advance. He is required to pay certain amount of monthly premium to avail the facilities such as emergency care, doctors' visit, lab-tests, or x-rays offered by the Health Maintenance Organizations (HMO). Some Health Maintenance Organizations (HMO) arranges visits of doctors to the client requiring some small amount of 'co-payment' paid by him.

The insured person can select his choice of doctor and hospital from the list provided by the Health Maintenance Organizations (HMO). The doctor chosen by the insured person work as primary care doctor who monitors his/her health condition and in case of special care refers him to a specialist.

A person who is interested in buying this plan should ask questions regarding the HMO plan cost, list of doctors, services offered by the Health Maintenance Organizations (HMO), and co-payments before enrolling for it.

Preferred Provider Organizations (PPO)

Preferred Provider Organizations plan (PPO plan) offer more flexibility than HMO's. A person can choose a doctor, hospital, or health provider from the arranged Preferred Provider Organizations (PPO) network or also from outside the network. But the amount to be share by the insured person will be high while choosing health providers outside the network. Again, the benefits available will be less in case of outside network.

The plan does not allow insured person to calculate out-of-pocket costs as possible in the HMOs. The choice of primary care doctor is like same with the HMOs.

Again, the person who is interested in buying this plan should ask questions regarding the choice of doctors from the Preferred Provider Organizations network (PPO network), hospitals available, or health care services offered by the plan before enrolling for it.

Point-of-Service Plans (POS)

Point-of-Service Plans (POS plans) are indemnity options offered by some HMOs to allow the insured person to control his health care without any reference from primary health care doctor. The insured person can also choose health provider outside the network, but for that he has to pay some amount of coinsurance. The three 'point of services' choices available to the insured person at time of need include primary care doctor under HMO plan, Preferred Provider Organizations provider (PPO provider) under PPO network, and services outside HMO and PPO networks.

Ways to get health insurance plans

Many people get their health insurance from the company they are employed in through group insurance coverage. In case, the person is self-employed, unemployed, or working in a small company he can avail the insurance through individual health insurance schemes. An insurance agent can help a person to get the right policy according to his income.

A person can get an affordable health insurance policy from the given choices:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA)

: It helps a person to continue with his company's insurance policy after leaving it. Through this, college students are also able to get same insurance policy which their parents have.

  • Worker's Compensation

: It includes compensation given by the company to his employee at the time of work related injury or accident.

  • Medicaid

: The policy is made for those people who come under low-income group and cannot afford the expenditure of costly insurance policies. There is particular eligibility criteria set by the state government to enroll people under this policy.

  • Medicare

: Medicare policy is provided to elder people who are six-five years or more in age and to the disables by the government and administered by the Social Security Administration.

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