By Alden Smith
HMOs - PPOs - Self Directed Health Plans - Choosing the Right Plan
Being without health care is just not an option for anyone. Even though the cost of health care is at an all time high, you face certain bankruptcy if you become ill or hurt in an accident that requires surgery of any kind, or a stay in the hospital. If you find yourself without insurance, such as after losing a job, then it is of the utmost importance to you to choose a health care plan that will meet your needs.Common sense tells us that the best time to look for a health care plan is before we need one. Ofttimes, a person struggles with what kind of coverage they might need, or whether or not to choose an HMO, a PPO, or all the things in between. It is a daunting task to attempt to wade through all the jargon in an insurance policy. The scope of this article is to give you a checklist to help you evaluate the best health care plan to meet your needs.
There are many types of health care plans. These can include:
1. The typical indemnity plan. This type of plan is what most people are familiar with. It pays for most health care needs, but lacks in the preventative care concerns, such as annual checkups or well child office visits.
2. The Health Maintenance Organization, or HMO. HMO's generally cover all your health care needs. Hospitals stays, annual physical exams, and immunizations are typically covered. A copayment, between $5 and $40, is generally charged at time of service. With this plan, you must use primary care providers and hospitals that are in the HMO's network. A list of these care providers is typically provided for you.
3. The Preferred Provider Organization. This plan provides care for a small fee paid per visit. The stipulation is you must choose from the list of health care providers in the PPO network. You have the option to see a doctor out of the PPO network, but be prepared to pay a larger portion of the bill, and plan on paying a deductible.
Once you have decided to choose a health care plan, you must evaluate your needs. If you are young and healthy, earn a good wage, and see the doctor little, then a high deductible plan with low premiums will suit your needs.
If you are a family with young children about to begin school, you will be getting immunizations for the children, will be making more trips to see a pediatrician, and need a plan that offers low copayments. Urgent care coverage is also a must when the family includes young children.
If you are 40-50 years old and have a bad back, you need a plan that will allow you to see specialists without the referral process, and will want to be sure that your prescriptions are covered under your new health care plan.
Keeping these factors in mind, ask yourself the following questions:
- How much is the monthly premium?
- Can I see my own primary care physician and have access to specialists if needed?
- How does the health care plan deal with pre-existing conditions?
- Are and pre-natal visits maternity care covered?
- Does the plan provide for well child coverage?
- How do I minimize out of pocket expenses under this plan?
- What is the percentage of copayment on such things as doctor visits and prescriptions?
- Is urgent care covered if I need to visit an emergency room while traveling?
These basic questions give you a place to begin. They cover most situations, but you must also consider things that you normally wouldn't. We have no guarantees that our families or ourselves might not need chronic care in the future. Even though you may be healthy and never see a doctor, you never know when disaster may strike. Consider the following things:
- Is there treatment for chronic care?
- What percentage of surgical care is covered, and what percentage of the cost of hospital stays?
- Is there coverage for outpatient surgery?
- Are consultations with specialists covered as needed?
- Are x-rays and laboratory tests covered?
- What about hospice care for the terminally ill?
- Is mental health care covered, and the price of drugs for these needs?
- Is there coverage for alcohol and drug related addictions?
Armed with this information, and asking yourself these questions should give you a good idea of where to begin when considering a health care plan. A lot of good information is available online, and you can compare plans through the variety of websites that provide insurance coverage for persons who are attempting to determine the best health care plan that will suit their needs.
HMOs - PPOs - Self Directed Health Plans - Choosing the Right Plan
Alden Smith is an award winning author and regular contributor to DoItYourself.com. He writes on a variety of subjects, and excels in research.
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