How to Choose a Health Care Plan
Wednesday, June 2nd, 2010 by adminToday, health care plans offer a wide variety of choices that can make this very important decision a very difficult one. Following are a few things to consider in choosing a health care plan which best suits the needs of you and your family.
Knowing the difference between healthcare organizations can help. Health Maintenance Organizations (HMOs) usually have an in-network of doctors and require a co-payment fee for each medical office visit or purchase of prescription drugs. The co-payment fees are generally nominal compared to the cost of the service. However, you should find out if your doctor is a part of the HMO's in-network of doctors. If not, determine your cost for seeing an out-of-network doctor. Also, HMOs usually require a referral from your primary care doctor in order for you to see a specialist. Because health care rates are important, be aware that HMOs generally provide a more budget-friendly option with usually the least amount of out-of-pocket expenses and often no claim forms to fill out.
Preferred Provider Organizations (PPOs) also have a healthcare provider network, but offer the flexibility of easily obtaining services from doctors outside the network. However, visiting a doctor outside the network can substantially drive up costs and sometimes makes it more difficult to budget your medical expenses. Deductibles (a form of co-insurance that requires the insured to pay a specified amount or percentage before the insurance company begins paying healthcare costs for the insured) are usually associated with PPOs.
Point of Sale (POS) Organizations function as a combination of the HMO and PPO plans. For services with doctors in their network, the POS plan functions as an HMO, complete with co-payments due at the time of service; for services outside the network, it functions as a PPO, requiring a deductible but providing flexibility to see specialists or other out-of-network service providers without referral.
Finally, Fee-for-Service health insurance is the least restricting and most expensive option available. This traditional health care plan allows the insured freedom to choose any doctor but requires expenses to be paid entirely upfront. The insurance company reimburses the insured, usually for about 80% of the total fee. However, with rising health care rates and tightening budgets, for many this option isn't really an option at all.
Assessing your overall healthcare needs first will help determine the option that's right for you. Are pre-existing conditions involved? Do you require frequent doctor visits? Will you need dental and/or vision coverage? Can you meet the deductibles? What are the costs of your monthly prescriptions? Answers to these questions may help align your plan to your needs.

