Health Insurance
According to Lesley Alderman, “With Americans spending an ever increasing
amount on medical costs, it's more important than ever to have insurance
that fits your health care needs. So when you start shopping for a plan,
don't just look for one with the lowest premiums. Consider the services that
are most important to you. The best place to get health insurance, of course,
is from your employer. Group plans are typically cheaper, and your employer
will probably cover much of the cost.”
There are three main types of coverage you can choose from: H.M.O.s
(health maintenance organizations), P.P.O.s (preferred provider
organizations) and the newer option called an H.D.H.P. (high deductible
health plan) paired with a savings account. A small number of companies
still offer old-fashioned, fee-for-service plans, but their ranks are dwindling.
Here's what you need to know about the most common plans:
H.M.O.S provide comprehensive coverage at a low cost to the consumer. In
general, you don't pay any deductibles or co-payments for basic care (and if
you do, they will be relatively low).
But your choices will be limited. You can generally use only the doctors and
hospitals within the H.M.O.'s network, though more plans are easing up on
this restriction, and your designated primary-care physician will determine
the level of care you require and when you need to see a specialist.
Pros: Low cost. Coordinated care.
Cons: A limited choice of providers. If you go out of network, for example to
a specialist, you will probably not be reimbursed.
PREFERRED PROVIDER ORGANIZATION AND POINT OF SERVICE
plans were created in response to consumer frustrations with the limitations
of H.M.O.s. You can choose to go to network providers and pay a small copayment,
or go out of network and have only a portion — typically around
60 to 70 percent — of your costs reimbursed. The main difference between
the two is that a point of service plan requires a referral from your primary
care physician to see a specialist, while the preferred provider plan does not.
Pros: More flexibility than an H.M.O.; lower overall out-of-pocket costs than
a fee for service plan.
Cons: It's tricky to predict your costs unless you're willing to stay within the
network. Getting reimbursed for out-of-network claims can be a hassle.
HIGH-DEDUCTIBLE HEALTH PLAN
Over the past few years, more
employers have begun to offer the option to sign up for a high deductible
health plan that is linked to a health savings account or health
reimbursement account. Some employers may offer the high-deductible
health plan on its own and allow the employees to set up a savings account
“The Most Important Things You Need to Know Before You Buy….”
Health Insurance
A health savings account allows you to put away pretax dollars and then
withdraw the money to pay your out-of-pocket costs. (Your employer may
kick in some money, too.)
Let us at SoCal General Insurance Agency help you find a plan that best fits your budget and needs.
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