Medical Insurance - Health Insurance Coverage & Plans Explained
If you're trying to decide between health insurance plans, you'll find that there are several different kinds from which to choose. It's important that you weigh all your options carefully. Your health insurance, even with an employer contribution to the cost, is very likely to be your largest regular monthly expense other than your rent or mortgage. The plan you choose needs to be more than affordable. It will affect your family's choices in doctors and health care as long as you are a member of that health insurance plan.
Health insurance is like any other kind of insurance. You pay a monthly amount, called a premium, to an insurance company in return for 'benefits', to be paid out as needed. Depending on the kind of plan that you choose, those benefits might include regular doctor's office visits, checkups, emergency room services and hospitalizations, and treatment by specialists. Some health insurance plans also offer benefits that are called 'wellness benefits.' like discounts on health club memberships, stop-smoking classes, and nutritional consultations.
The main types of health insurance plans are:
HMO - Health Maintenance Organizations
HMO benefits are geared toward keeping you healthy. They aim for affordable health care costs by reducing the cost of annual physicals, well-child visits and other routine care by requiring you to pay a 'co-pay' - a small portion of the actual bill - for every visit to your doctor, and the health insurance company pays the rest. Most require that you choose a primary care physician, who takes the place of an old fashioned General Practitioner - the family doctor who knew your medical history and prescribed visits to specialists if needed. HMOs are generally more affordable than traditional health insurance, but theyll still cost you several hundred dollars a month.
All your medical care under an HMO will be arranged through your primary care physician. If you need to consult with a specialist, you simply call your primary care physician and request a referral.
Preferred Provider Health Insurance Plans
PPH health insurance plans are very similar to HMOs. They also attempt to keep overall medical costs affordable by providing both preventive and catastrophic health care coverage. Unlike most HMO's, though, you can usually choose to visit any physician or other provider registered with the preferred provider network. You'll pay a co-payment, and your health insurance will cover the rest.
Catastrophic Health Insurance Plans
Catastrophic health insurance plans are also sometimes called 'fee for service' plans. They generally will pay out to any provider, but they strictly limit the kind of health care that they'll cover. In most cases, you're only covered for illness or injury. There's no coverage provided for regular checkups and other office visits. Catastrophic health insurance plans are often the most affordable option, since they only pay off if you become ill or are injured.
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