Guest Blog: A Simple Guide to a Complicated Health Care System

This article was written by Jodi Smith of HealthInsuranceQuotes.org, an online resource for those seeking the best health insurance quotes.

HMO, PPO, POS… Huh? If you look at these commonly used acronyms and are completely clueless as to what they mean, you’re not alone. Millions of intelligent, competent individuals are at a complete loss when it comes to translating health care jargon. And it is by no fault of their own: most health insurance providers provide little to no education when it comes to the ins and outs of the United States’ health care system, and just want you to go online and get health insurance quotes from them without asking any questions. Well, that’s where we are going to come in and attempt to provide you with a simple guide to a health care system that has been described as complicated, ambiguous, and clustered at best.

There are Basically Four Ways to Go

For all the complications and intricacies of our nation’s health care system, there are essentially four types of health plans you can utilize for your health care needs:

  1. Indemnity Insurance (AKA Fee-For-Service Insurance) The most traditional insurance coverage, indemnity insurance pays for most of your health problems, but generally won’t pay for routine physicals or preventative health care like booster shots and vaccinations. It usually has a high premium cost (monthly out of pocket cost you must pay to the insurance company), but does not limit you to any specific network of doctors or health care providers.
  2. HMO: Health Maintenance Organization An HMO will cover most of your health care needs, including yearly physicals and vaccinations, for a small co-payment which is paid to the medical service provider. However, an HMO will limit you to a list of affiliated doctors and hospitals, or they will not cover your care.
  3. PPO: Preferred Provider Organization A PPO will cover most of your health care needs for a small per-visit fee. Your fee will be less if you choose to see a doctor that is on the list of “preferred providers,” and more if you venture outside of this list.
  4. POS: Point of Service Point of service plans offer you two options for using them, both of which are similar to other types of insurance:
    i.) You can use the POS plan like an HMO, choosing physicians from a list and paying a small co-payment per visit.
    ii.) You can use the POS plan like an indemnity plan, choosing your own provider while being responsible for a percentage of your bill.

Time to Choose One

Now that you know the four types of health plans, it’s time to choose one now, before you’re actually sick and need one. Many people who are young, healthy, and don’t often use medical services are under the mistaken impression that they do not need health care coverage. However, all it takes is one car accident or mild to moderate illness to empty a significant amount of money out of your bank account in medical bills and service fees. Best to purchase some type of health care plan now to avoid financial ruin.

The first step in choosing a health plan is to choose a doctor that is right for you. If you already have a primary physician that you wish to keep, find out which type(s) of plan(s) they participate in. Second, consider your medical needs; are there specialists you regularly see that require you to be able to quickly get an appointment with them without a referral? Certain plans will accommodate this, and certain plans will not. Finally, are there specific hospitals or facilities you like, or that specialize in specific medical services that you routinely utilize? Choosing a plan that is affiliated with these providers will be particularly important to you.

Some Simple Questions to Ask

Once you have narrowed down to a few plans and have obtained health insurance quotes from their respective companies, there are several questions you must ask to finalize your decision:

  • Can I keep my primary care physician(s)?
  • Will maternity care be covered?
  • How will an ongoing, chronic condition be handled?
  • Will I be required to fill out claim forms?
  • Will vaccinations and preventative care be covered?

Finding a plan that minimizes out of pocket expenses while maximizing coverage is the goal of anyone who is trying to navigate our health care system. Following these steps will make things easier on you and your family in the coming year.

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