Health insurance options for you.

There are many choices for individual health insurance plans out there.  This article will talk about three of those options. First, let’s talk about a standard healthcare policy called Major Medical to contrast it.  Major Medical, also sometimes called “Catastrophic” insurance is the most basic type of health care coverage. It’s designed for young, healthy people who aren’t likely to have very many doctor visits and few if any prescription drugs. It generally does not cover prescription drugs.  They have something called a deductible amount of money you have to pay upfront before the insurance company starts to help pay.  The deductible can be anywhere from $500 to $1000 or more depending on how much you want to pay for a monthly premium. The higher the deductible is, the lower your monthly premium. The upside is you can choose whatever doctor you want anywhere that takes that insurance and the monthly premium is among the lowest for healthcare coverage.  The downside is after you pay your premium and your deductible, you still have to pay a portion of the bill until you reach your maximum out-of-pocket expense for the year. The deductible is included in the maximum. This additional amount is called coinsurance and is generally 80/20 where the 20 percent is your portion.  After that they pay 100 percent to the “lifetime maximum” which is the maximum the policy will pay out and then it expires.
 
Individual health insurance plans all generally have a “network” or group of doctors to choose from.  An HMO, or Health Maintenance Organization has the least freedom of choice of doctors and locations for treatment, but is also the least expensive. With an HMO you pay a low monthly premium with low co-pay. A   co-pay, not to be confused with coinsurance, is a generally small payment you pay before a doctor’s visit. It is generally something in the $10 to $20 range.  So you pay your low premium, your low co-pay, and the HMO pays the rest and does the billing for you. There also is no lifetime maximum generally with these policies. The downside is the your freedom of choice of doctors and locations to get care at. They have you pick a PCP or Primary Care Physician. If they can’t provide a service, they have to refer you to someone in the network of doctors. Also, there is no coverage if you go outside the network.

If you want freedom of choice, you can have it, but it will cost you. A PPO, or Preferred Provider Organization, does things differently than an HMO. They have their own network of doctors, but don’t require you to go inside the network. So you do have freedom of choice. The downsides are your monthly premiums are a bit higher than an HMO; they pay a lesser percentage when you go outside their network, and you have to do more paperwork through the process of reimbursements.

A POS, or Point of Service Plan, acts like an HMO within the network, and like a PPO outside the network. You have a Primary Care Physician and a low co-pay inside the network like a HMO. Outside the network you generally have a high co-pay and a deductible. So it can give you the advantages of both a HMO and PPO. How the monthly premiums compare to a HMO, you will need to shop with online quotes to see.