Healthcare - We Do Have Options

When it comes to Healthcare Insurance, most of us, at the mere mention of the term become glossy eyed and turn a deaf ear to the matter. Health Insurance seems to a no-hope pipe-dream for most of us. At the same time, though, how many of us have actually taken the time to research what types of help are available to us when we need it? Well, look no further as I have taken the time to provide you with a little introduction to the various paths you can take in order to cover potential medical costs!

The Four Pillars of Help

• Indemnity or fee-for-service plans
• Preferred Provider Organizations (PPOs)
• Health Maintenance Organizations (HMOs) and
• Point-Of-Service (POS) Plans.

Idemnity (fee-for-service)
Under this type of insurance you choose your doctors and care providers. The normal protocol states that you pay a portion of your medical fees upfront and then have your insurance provider pay around 80% of the remaining bill (depending on the plan you have). With some providers, you may have to pay the bill upfront and then submit your receipt to the insurance company, or, the insurance company may be billed directly once your deductible has been payed. The use of this plan though, may get you into a sticky situation if you are not careful in some decisions, as generally the insurance provider will only pay for 'reasonable and customary' expenses as well as 'shop-around' for other providers to determine their rates. So, if your doctor is more expensive then the average you will end up paying the overage.

Preferred Provider Organizations (PPOs)
The design of the PPO network is as follows. PPOs consist of chosen medical providers that you 'should' choose for your medical needs. This network of medical providers has an agreement with their PPO that allows for lower-cost care. The catch is, if you stray from the chosen network of your PPO, you will either have to pay the bill upfront and then submit the receipt the PPO for about an 80% reimbursement, or, pay the difference between what the PPO network would have cost and what your doctor charged. With this plan, you are free to refer yourself to any specialist within your PPO network without asking. Choosing an out-of-network specialist is the same as choosing an out-of-network doctor.

Health Maintenance Organizations (HMOs)
This type of plan is the least expensive and most in-flexible. It is also more preferable to groups rather than individuals. HMOs work like this. When you sign up for their plan, you essentially agree to only see any doctor that they have within their network. In exchange the deductible is very low and sometimes non-existent. The problem is, if you are not yet incapacitated you will likely have to wait for clearance before you can head to the Emergency Department. If you choose not too, or can't wait you will likely have to pay for the bill yourself.

Point-of-Service (POS) Plans
Point-of-Service plans are the same concept as PPOs, except you now have a Primary Care Physician that you must choose from the list of those available. The difference in these plans comes into effect when you wish to refer yourself to a specialist. You must now get a referral from the Primary Care Physician. Failure to do so could result in higher out-of-pocket expenses and more hassle, as well as losing the coverage for your visit.


So, there you go! Now that you have a basis for the types of services you can look into for yourself and your family you should consider further research to determine if any of these plans could in fact be affordable and could become fully integrated into your budget!