subject: A Guide To Understanding Your Medical Insurance [print this page] The ability to obtain insurance is in a state of upheaval, as politicians, doctors, and health insurance coverage providers are pitted against each other with the consumer laid bare on a gurney between them. This atmosphere requires that a consumer be educated concerning each different aspect of the current medical insurance game in order to protect themselves against the possibility of being left without adequate coverage. This education begins with the three major versions of medical insurance; P.P.O.s, H.M.O.s, and H.D.H.P.s.
P.P.O.s
Preferred provider organizations provide more flexibility than the next major version of health care, H.M.O.s, in that they tend to allow insured members to visit doctors outside of the preferred provider network. Health care providers outside of the P.P.O. network are typically only allowable if a referral from a primary care physicians is obtained first, although being in a point of service plan style P.P.O. will wave this need.
Typical visits to out of network specialists or doctors is handled through a reimbursement process wherein a certain percentage-depending on the plan's coverage-is returned to the insured following receipt of payment. This reimbursement process can be difficult for members of PPOs, and is considered by many to be the most significant drawback.
H.M.O.s
Health maintenance organizations are considered by many to be the most well known of insurance coverage plans, as most employers utilize them. H.M.O.s differ from P.P.O.s in that they are significantly less expensive where deductibles are concerned, and many of those covered are often not even required to pay deductibles for basic care.
The choice of specialists and health care providers is limited in an H.M.O., however, and provider networks are frequently small. Many H.M.O.s are easing up on the restriction as P.P.O.s begin to obtain more market share, but a limited choice for health care when in an H.M.O. remains the biggest concern.
H.D.H.P.
The High-deductible health plan has been begun to be implemented by more and more employers as an alternative to high premium cost coverage. The aim of H.D.H.P. plans is to allow relatively healthy employees and their families to pay minimum monthly amounts while still being capable of obtaining emergency coverage if needed.
H.D.H.P. plans require both the plan itself, and a savings account that may perhaps or might not be facilitated by the employer providing the plan. The savings plans is a tax free method of withholding money for the purposes of out-of-pocket expenses, and in many cases also has small contributions from employers.
The most obvious downside to H.D.H.P. plans is the deductible cost, which can be prohibitive if a family member or employee falls chronically ill.
by: Ethan Kalvin
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