How To Choose The Right Health Insurance: Pt 2

In addition to understanding what to look for when choosing a health insurance plan, it is important to understand the difference between the types of health insurance in order to choose a plan that directly meets your individual needs.

Some health insurance plans allow you to choose your physicians but have a higher premium cost, while other health insurance plans have a network of physicians rather than allowing the individual to choose and these plans tend to have lower premiums.In addition there are several different options for health insurance plans for those individuals that are self-employed, as well as those that are eligible for state funded health insurance such as Medicare or Medicaid.

Understanding each plan and how each works will allow the employee to ensure they are getting the most out of their coverage, and that their coverage will work for them in their time of need.

There are two major health insurance plans that are often available as options to employees that work for large companies. One of these health insurance plans is known as an HMO, a Health Maintenance organization. The other type of health insurance is known as a PPO, which is defined as a Preferred Provider Organization.

An HMO works in the following way: An HMO is focused on preventative medicine, and one’s total health. So an HMO is based upon a network of doctors that oversee your health needs, with a primary care physician being in charge of your overall health. If you were to get sick, your primary care physician would be the first person that you would see. He who would then refer you to a specialist. Otherwise your HMO health insurance might not cover a visit to a specialist.

However, the primary care physician you see can range from a family practice physician, to a gynecologist, to an internist. When one chooses an HMO, the first step is to choose a primary care physician. It is important before choosing the physician, to have a good understanding of the network of doctors that that physician works with to ensure that the HMO network can cover all necessary health needs.

In addition there are emergency situations that may or may not be covered by the HMO. Hospitals also fall into a network for HMO’s. Therefore if there is an emergency and an individual is taken to a hospital that is outside of their HMO health insurance network, there is usually a time period of 24-48 hours where the health insurance company must be contacted in order to receive what is known as a pre-certification ( a confirmation from insurance).This states that the insurance will be willing to cover the visit. In non-emergency hospital visits, a precertification is also necessary if the hospital is out of the HMO health insurance network.

A PPO on the other hand works in the following way: In a PPO unlike in an HMO, there is no primary care physician that oversees to overall health of the patient. Due to this, the patient is able to see whatever specialist that they choose. However, because there is no overseeing physician, they will often need paperwork to bring to the specialists. So it is the job of the individual to find out what kind of paperwork is necessary.

In addition, although a PPO had similar benefits to an HMO, it has more flexibility. This allows PPO health insurance companies to charge higher premiums. However if individuals choose a doctor that is already in an HMO network they may pay a lesser premium.

Both types of health insurance, HMO's and PPO's are capable of covering the well-being of an individual or family, it simply depends on how much flexibility is needed in choosing physicians and specialists, and what the health insurance budget is for each individual or family.

It is important that even after choosing a type of plan that is right that one shops around to ensure that the plan they chose will cover all aspects of their individual well being.

* Information retrieved from:

http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm