| Health insurance is a necessity for all individuals. This is | | | | pay in co-insurance, the lower your premiums. |
| because even a minor illness can quickly become a | | | | Managed care plans use "networks." This means that |
| life threatening condition that you can cost thousands | | | | you have to choose from a specific list of doctors, |
| of dollars to treat. Many illnesses have been financially | | | | clinics, hospitals and health care providers. These |
| devastating to many people and families and having | | | | providers are contracted with your plan to provide |
| adequate health care can assist you in covering those | | | | services to members of the plan. Some managed |
| medical expenses as well as helps to ensure that you | | | | care plans will require that use only providers in the |
| can afford preventative medicine as well. | | | | plan for your routine care. Others will pay for care |
| It is important to understand how health insurance | | | | from any provider, but offer you more financial |
| coverage works before you purchase a plan. The | | | | incentives for sticking with those in the network. |
| health insurance plan that you choose must meet | | | | Managed care plans are usually a more affordable |
| your needs as an individual or family. There are | | | | option. Managed care networks provide healthcare |
| several different types of health coverage available | | | | professionals with "built-in" clientele, thus allowing |
| and having an understanding of health plans can help | | | | them to lower their rates. These plans also |
| you choose the right one. | | | | emphasize preventative care to keep medical |
| Health care plans will typically pay for most, and | | | | conditions at bay. In general, the trade-off for these |
| possibly all, of the cost of treatment for illnesses and | | | | programs is that you may not be able to use your |
| injuries. These are usually classified as "managed care" | | | | doctor of choice, but you will receive increased |
| or "fee for service." | | | | affordability. |
| Most people are familiar with "fee for service" plans | | | | There are three types of managed care plans |
| and they are often referred to as "indemnity plans." | | | | including: |
| These are plans that are sold by traditional insurance | | | | Â- Preferred Provider Organization Plans - These |
| companies and you can go to any doctor you want | | | | allow you to go to any provider you wish, but you |
| and you don't require a referral if you need a | | | | will save if you use providers that are in the network. |
| specialist. A fee-for-service plan will often pay for | | | | You do not have to select a primary care physician |
| most of the costs of treatment for medical | | | | for a PPO plan. |
| conditions that are covered in the policy. In most | | | | Â- Health Maintenance Organizations - These |
| cases, your healthcare provider will bill the insurance | | | | require you to only receive care from providers |
| company directly for the cost of your care, but in | | | | within the network. There are exceptions should a |
| some instances you may have to pay the bill and | | | | medical emergency occur. With a HMO, you will have |
| then file a claim for reimbursement with the insurance | | | | to choose from a "primary care physician" list. Your |
| company. With a fee-for-service plan, you will be | | | | physician will oversee your medical care and provide |
| required to pay a premium, deductible and | | | | you with referrals to specialists and other providers |
| coinsurance. | | | | you may need. |
| Co-insurance is the portion you have to pay once | | | | Â- HMOs with a POS (Point-of-Service) - If this will |
| you have met your deductible and the plan begins to | | | | allow you to use a healthcare provider outside of the |
| pay benefits. Generally, your plan will pay 80% after | | | | network, without first having to receive a referral. |
| the deductible has been met, but you are then | | | | However, you will pay more for using those |
| required to pay the leftover 20%. The amount that | | | | providers. A POS plan may also exclude the option |
| the insurance company pays depends widely on the | | | | for out-of-network care in certain medical situations. |
| state you live in. As with a deductible, the higher you | | | | |