What do PPOs, HMOs, and POS plans have in common? They are all forms of managed health plans, and you need to be familiar with them when you shop for health insurance. PPO means preferred provider organization; HMO means health maintanence organization, and POS means point of service. In general, managed care plans provide their members with health care from within a network of providers. In other words, members can only go to certain doctors and hospitals that belong to or agree to participate with a particular network. Managed care plans also take care of claims processing that result from a medical service.
A health maintenance organization generally provides the least expensive medical care. HMOs offer medical services in exchange for a fixed monthly premium. However, HMO clients have no freedom to choose their own doctors and hospitals and can only use providers in the HMO network. Doctors belonging to a particular HMO normally refer patients to other HMO doctor members, and a referral from an HMO primary care doctor is needed in order to see a specialist.
A preferred provider organization, or PPO, allows its members greater lattitude in choosing which doctors they can see. Physicians within a PPO make referrals, but the members can refer themselves to doctors and specialists including those outside of the plan. However,though members have the freedom to go outside of the PPO and will still receive coverage, they will pay more for seeing providers out side of the PPO network.
In a point of service plan (POS), Primary care doctors refer members to other doctors, usually within the plan, but members can refer themselves outside of the plan, though they will pay more. If POS doctors refer a patient outside of the plan, the POS usually pays most of the fee. Participants in these plans choose their own doctors and hospitals, and can refer themselves to whatever doctor or specialist they choose.
It is also important to understand fee-for-service, or FFS, plans. These are not really managed care plans in the sense that there is a pre-existing network of providers in place. Fee For Service plans are often much more expensive in comparison to HMOs and PPOs. However, FFS plans allow participants greater lattitude in who they can see. FFS beneficiaries can choose what doctors, and specialists they prefer to see and what hospitals they can go to. In an FFS, what determines what provider members use is whether or not the provider accepts the insurance. Normally, FFS plans require much more in out-of-pocket expenses and require members to pay in full up front and then file for reimbursement.
The plan you ultimately choose will depend on personal needs, whether or not you are single, married, married with children, whether or not the insurance is available in your geographical area, and of course, the amount of income available for health insurance. One very important point to remember is that health insurance, as all insurance, is protection. The better you understand the kind of protection you need, the better your choice will suit your needs.
Supplemental Health Insurance Plans
Let's face it the cost of health insurance plans has been rising about 8% each year. Sadly, this doesn't appear to be getting better either. It may shock you when you realize the simple truth. HSA type catastrophic health plans are much more affordable.
Let's look more closely at the Blue Options HSA plan first.
Why Blue Options HSA plans don't get much consideration:
* People don't understand HSA plans
* They probably never had one offered to them at their job.
* The deductible appears to be very high
* They sometimes believe that the plan is of no use unless the deductible is met
* They have fear of something they don't understand
* They don't know that they can take pre-tax dollars to pay for medically related expenses
* Most people don't understand the concept of statistics and probabilities
* The agent they are using doesn't want to take the time to explain a new plan concept
Let me entice you with some cost comparisons:
In NC, the Blue Options HSA plan for a 29 year old male and a 28 year old female is $237 per month. This plan has a maximum out-of-pocket expense, if either one has to be hospitalized of $5000.
Let's take and example: Jim has to have his gall bladder removed. The cost of the operation is $22,000. What does Jim have to pay? He has to pay $5,000. The insurance company pays the balance due. of $17,000. Heart bypass surgery might cost $130,000 and you would still be out-of-pocket the same amount. It would only cost Jim $5,000 out of his pocket.
Blue Advantage Plan for the same 29 year old male and the 28 year old female is $272 per month. This plan has a maximum out-of-pocket expense, if either one has to be hospitalized, of $5,500. Therefore, the gall bladder operation would cost Jim $5,500 instead of $5,000.
Think about it. The couple have to pay $35 per month more - or $420 more per year to have the Blue Advantage plan.
That doesn't sound too good. You have to pay more every month for the Blue Advantage plan and if you have to use the insurance for a catastrophic occurrence, you pay $500 more out-of-pocket.
So why is the Blue Advantage plan the most popular plan in North Carolina?
The Blue Advantage plan easy to understand, first of all. People like the fact that they can see a doctor for $25, or $50 for a specialist. Medications are only $10 for generic, $35 for preferred brand drug after a $200 annual deductible.
Here's the story: People are afraid that they won't be able to see a doctor for a sick visit without it costing more than their budget can stand.
If you are insured by the Blue Options HSA plan it will cost you more to see a primary doctor, $60 and about $80 to see a specialist. Therefore, to see a doctor you will pay $35 or $55 more.
Let's look at this comparison more closely. On average, people may have to be hospitalized once every 9.2 years. Young healthy people need to see a doctor once per year for a thorough check up. In addition, most young healthy people see a doctor for a cold or other minor health problems one additional time per year.
Shouldn't young healthy people have a catastrophic plan such as the Blue Options HSA plan? Yes! A catastrophic plan will help them get the care they need and the Blue Options HSA plan costs less than the Blue Advantage plan.
Both Evan Davis & Richard Day are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Evan Davis has sinced written about articles on various topics from Insurance, Insurance Quotes and Insurance. . Evan Davis's top article generates over 5400 views. to your Favourites.
Richard Day has sinced written about articles on various topics from Internet Marketing, Health Insurance and SEO linking. Richard Day of is one of the premier health insurance agents in the southeast. He has a strong desire to educate his clients. Insurance plans. Richard Day's top article generates over 27100 views. to your Favourites.
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