It is very complicated choosing a healthcare plan today. The options to choose can be overwhelming. And the industry terms that are in the plan descriptions make it even harder to compare health insurance companies — hence making it nearly impossible to make the best choice. The first step to a smoother buying process is to find out the most suitable plan for you. The three managed care plans popular among both individuals and employers:
- health maintenance organizations (HMO)
- point of service
- preferred provider organizations (PPO)
Health maintenance organization (HMO)
HMO plans are one of the most popular health care plan chosen by American consumers. Generally, these plans have a higher level of benefit, lower premiums, and restricted freedom of health care choice.
Pros of HMO 1. You can predict your out-of-pocket expenses due to copayments.
2. Your overall out-of-pocket costs reduce significantly. How does an HMO plan work? You only get in-network services with HMOs. Some insurers work out their service pricing with health care providers and doctors. Others, like Kaiser Permanente, have their healthcare facilities and employ their doctors. The ensues pooling experience allows them to develop an effective pricing structure.
The restricted networks of HMOs help provide a higher level of benefit to people on this plan. Your choice of facilities and doctors is limited to those within the network of your insurer. If you receive care outside of your network, you'll be responsible for all of the costs. However, this doesn't hold in emergency services with an unavailable in-network provider.
Point of Service (POS)
POS plans share similar features with both PPO and HMO plans with changing benefit levels, which are determined by whether you receive in- or out-of-network care.
Pros POS 1. You can see out - or in-network providers.
2. If you're directed to an in-network provider, your charges will be equivalent to out-of-network fees. How does a POS plan work? Those with a POS plan can self-refer. This implies that you require a referral to visit a specialist. Or, you can be referred to a doctor or facility by your PCP. However, you may sometimes need to see an out-of-network specialist. If you have an understanding with your PCP and they make the referral, the ensuing cost is covered by your POS plans as if the provider is an in-network provider.
On the other hand, if you self-refer to an out-of-network provider, you'll cover the higher out-of- pocket costs. In some cases, you will have to bear the full cost of the treatments you received.
Guide to compare health insurance companies
The following is a list of three of the country's top-rated insurance companies and the plans they provide.
CIGNA is one of the nation's most recognizable insurance carriers. It mainly focuses on PPO products, but also offers HMO and POS plans.
Kaiser is one of the nation's largest nonprofit insurance carriers. This carrier focuses primarily on HMO products, but it also offers POS and PPO POS plans.
Anthem Blue Cross
Anthem is a nationwide insurance carrier. Its primary focus is on PPO products. But it also offers HMO and POS plans. The plans can be more expensive than plans offered by other carriers.
So if you compare health insurance companies, you will find the best choice always comes out. You most likely won't have to choose your provider if you're getting coverage through an employer's health plan. However, many employers have a number of options. Carefully consider your regular health needs and your budget. Find out if you can afford to pay out-of-pocket in the event of a medical emergency.