Common Health Insurance Plans – What Are the Differences?
By: BankingMyWay.com Staff

Not all health insurance plans are created equal. And there's no rule of thumb that proves any particular plan better than another—after all, the best plan for one person may not be suitable for someone else.

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If you don't have an understanding of the basic health insurance plans, understanding your options can be a tricky ordeal. But don't worry: this guide will detail the pros and cons of each major plan, and can help you determine which plan is best for you.

Which Health Insurance Plan is Right for You? When choosing a health insurance plan, you'll likely find that the type of plan you choose, not the insurance company, will determine your level of coverage. The cost is the one factor that varies from company to company. Depending on your circumstances, you may be quoted different rates from different health insurance providers. If you're searching for a job, it may be a good idea to consult any prospective employers on their health care package, as some employers will provide more health insurance coverage than others.

Health Maintenance Organizations (HMO) HMOs are typically the most affordable way to receive medical care. HMOs offer a wide range of benefits for a set monthly fee and generally do not have deductibles. Rather, patients pay a portion of the cost, called a co-payment, for each office or hospital visit—typically a fraction of the overall cost. For example, a co-payment for an office visit usually costs around $20.

With an HMO, you choose a primary care physician from a list of participating doctors. If you need to see a specialist, need to be hospitalized or have lab or X-ray work, you must be referred to the facility by your primary care physician for services to be covered. Also, your doctor must give authorization for those services to be covered by your HMO. Services such as emergency room care, mental health and chemical dependency services may require additional fees.

Preferred Provider Organizations (PPO) PPO plans allow you to receive care from any medical physician. However, if you opt to visit a “preferred provider” from a list of participating physicians, your health insurance company will cover a higher percentage of the costs. For example, your plan may cover 80% of expenses if you are treated by a preferred provider, but only 60% if you are treated by a non-preferred provider. When you use a non-preferred provider, you may also be responsible for any amount beyond customary and reasonable charges.

If you choose to enroll in a PPO system, you will have choices to make. Your decisions will apply to you and any dependents you enroll in the plan, and can usually only be changed once a year during "open enrollment" periods. You'll receive a list of participating medical professionals, which you can use to find health care. Or you may continue to see anyone you already use.

You may have to pay a portion of the cost for each office or hospital visit, regardless of how much the visit costs. Your portion is the "co-payment." Also, you may have to pay extra for services such as a visit to the emergency room, mental health and chemical dependency services.

Point-Of-Service These plans combine characteristics of HMOs and PPOs. You choose a primary care physician who controls all aspects of care, including referrals to specialists. All care received under that physician's guidance, including referrals, is fully covered. Care received by out-of-plan providers is reimbursed, but you are required to pay a significant co-payment or deductible. In short, you decide each time you need medical care whether you want to use your plan as an HMO or a PPO.

Major Medical Major Medical is the least restrictive option of the major health insurance plans. Major medical lets you visit any licensed health care professional for anything covered by your plan. You choose a deductible amount when you enroll, and those apply to you and any dependents you enroll in the plan.

The deductible you choose applies to each person enrolled in the plan. Therefore, if you and a spouse enroll and select a $250 deductible, you each must pay $250 in medical expenses before your plan starts paying further costs each year. But insurance companies typically set a maximum of two or three deductibles per family.

Costs that exceed your deductible are covered by a coinsurance plan, so you and the insurance company share the cost for services covered by the policy. For example, with an 85/15 provision, the insurance company pays 85% and you pay 15%. After you meet your deductibles, coinsurance maximums apply that protect you from skyrocketing bills.

After deciding on what coverage is right for you, use InsWeb.com's online health insurance questionnaire to compare health insurance quotes online.

— For more ways to save, spend, invest and borrow, visit MainStreet.com.

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