Finance Tips

One of the more annoying features of the insurance world is its habit of distilling options down to simple sets of letters and then failing to clearly explain what the letters mean. In other words, insurers hide behind jargon and prefer not to explain clearly what you are buying. You are expected to assume the insurer has your interests at heart and pay over your money without a second thought. In many cases it works. Over the years, we have given up the unequal struggle and just say prayers we never fall sick. But, as premium costs have risen and the recession has cut back our spending power, trying to understand the options is back on the menu. So let’s start with an explanation of HMOs and PPOs. In fact, they both rely on a network of physicians, clinics and hospitals, but they differ significantly in the detail of how they deliver healthcare to you and your family.

A Health Maintenance Organization (HMO) is a network of healthcare professionals that enters into a contract with an insurance company. The insurer offers a captive group of people to refer to the network and, based on the expected volume of business, the network agrees a fixed fee for all the main services on offer. In theory, this works well for everyone. The fees are discounted because of the volume of business, so the insurer saves money and charges lower premiums. This is usually the cheapest form of health plan with very low copayments and, often, no deductibles. But there are problems. HMOs are very reluctant to accept people with existing conditions requiring expensive treatments. They prefer most of their patients to be reasonably healthy. The reason is basic economics. Every physician has to meet a quota of patients in a day. This means spending the shortest possible time on each consultation. Long diagnostic sessions disturb the quota and can result in penalties to both the doctors who miss their numbers and the patients who have slowed down the queue. There are also significant restrictions on patient choice. A nominated primary care doctor decides what referrals shall be made and to whom. HMOs are the cheapest form of care, but you have little control over the treatment you or your family receive.

A Preferred Provider Organization (PPO) uses the same basic approach but, because you pay more, you buy greater control over the treatment. The copayments are around 20% and there are usually deductibles. But, you have freedom to choose your own doctors. So long as you go see a physician in the network, you are covered. If you want to see someone outside the network, you usually only pay the difference between the network rate and the actual fees your choice collects.

So, when it comes to cheap health insurance, an HMO is the better option. But if you have the money and a health problem likely to need more extensive treatment, you should opt for a PPO. It always comes back down to your own personal needs and what you can afford. Cheap health insurance always comes with limitations. Read the small print before you buy into any plan and see exactly what you can and cannot do before you agree to buy the policy.

You want to insure your health and ask your insurance agent to offer you a good policy. You are given quotes and start thinking about buying a certain plan when the inevitable question is asked “What type of plan do you want to purchase?” This question has left many first-time insurance shoppers confused as they didn’t know about any plan types before. Too bad, because by choosing the type of insurance plan you will pay for determines how your coverage will be distributed as well as how your medical services will be provided. And as you may guess this is crucial when it comes to insuring own health.

But do not worry, this article will explain the essence behind each coverage plan type you can get in the US so the next time you will be asked the question of plan types you would choose the perfect plan to meet your requirements.

HMO (Health Maintenance Organization)

HMO plans are the most popular type of managed care distribution these days. They provide a wide spectrum of healthcare services you can receive for a reduced fee or free of charge. But the main catch is that you can receive them only at specific locations and from specific professionals. And you will have to choose a primary care physician (PCP) who will refer you to other professionals when needed. Without your PCP’s affiliations you won’t be able to receive coverage for the services you took. Neither will you be covered for the costs if you address someone outside the network.

PPO (Preferred Provider Organization)

PPO insurance coverage is quite alike to HMO. This type of managed care also requires you to choose a PCP, however you have more options when choosing this doctor. This is especially useful to those who have a good relation with their family doctors who might be outside the insurance company’s network. Moreover, you have fewer restrictions on out-of-network services, still you will eventually pay more for them if compared to in-network services.

POS (Point of Service)

POS health insurance plans also require you to choose a primary car physician. But you aren’t restricted to a network your insurance company has. Still, it will be impossible for you to get individual health insurance coverage if you don’t get a referral from your PCP before visiting any other doctor.

EPO (Exclusive Provider Organization)

EPO health insurance coverage is almost the same as HMO plans. There’s a PCP you have to get a referral from in order to visit a specialist and there’s a network of physicians and facilities you are limited to. The only difference is that you pay only for the services you received, while with HMO plans you have to pay a regular monthly fee.

Fee-for-Service

This type of insurance coverage is the oldest out there and least complicated to understand. You have no restrictions on where to get your care or whom to address. You only pay for the services you receive when needed. However, you get less coverage with such plans and your overall expenses tend to be higher than with managed care plans.

If you have ever dealt with health coverage plans you definitely know that there are various types of plans out there on the market, each of them having their special features, pros and cons. And it’s quote hard to say which plan type is better, because they all appeal to different customers and different situations. Just like you can’t say that coffee is better than tea, you can’t affirm that HMOs are better than PPOs. So if you are a bit confused with different plans and don’t know which one to choose, this short overview will definitely help you decide with type of health coverage to purchase when you decide you need one.

Health Maintenance Organization (HMO)

This plan type is probably one of the most popular and widely used amongst managed care plans. It delivers a very wide selection of services, including preventive care, regular exams, access to different specialists and medications. However, you are limited to a specific network of medical facilities and physicians you can receive services from. Moreover, you are required to choose a primary car physician (PCP) who will refer you to other specialists when needed. Otherwise, if getting your care outside the network or without your doctor’s referral you will have higher out of pocket expenses.

Preferred Provider Organization (PPO)

PPOs are practically identical to HMOs, taking the fact that you are also limited to a network of facilities and have to choose a PCP in order to receive care. However, you have more freedom when choosing your primary physician, which is especially helpful if you have a good relationship with your family doctor who is out of the network. And you usually get a wider network of facilities to receive care in. Still, any out of network services will be considerably more costly.

Point of Service (POS)

POS plans have strict rules concerning referrals. If you don’t have a referral to other specialists issued by your primary physician then you won’t be able to receive any cheap health insurance coverage at all.

Exclusive Provider Organization (EPO)

EPOs are very close to HMO and PPO plans. It’s the same type of managed care health insurance where you have to select a PCP and are limited to a network of hospitals and doctors you can get medical services from. But the main difference is that with EPO plans you pay for each visit to the doctor or service received when required in contrast to HMO plans where you have a monthly fee that should be paid constantly regardless whether you have used your coverage or not.

Fee-for-Service

Fee-for-Service is the oldest type of individual health insurance that was around ever since health coverage was introduced. With such plans you have total control over where to get your care and whom to address. You pay only for the services you receive and don’t need any referrals in order to get to a specialist. However, the fees are usually much higher than with managed care plans and many insurance experts say that the resulting out-of-pocket expenses are larger than the amounts of money you would spend on a managed care plan.

Now it’s up to you to decide which plan type works best for you. Analyze your situation, see what your options are and get the plan that would reflect your personal interest and would be most convenient to you personally.