Whether it’s a minor sickness, injury or a major disease, visit a doctor and the inflated medical bill will jolt you into looking for health insurance ASAP. Survey the market and you will find that there are two major individual health insurance plans, managed care health insurance plans and fee-for serviced plans.
The managed care health plans can be further categorized under the preferred provider organization (PPO) and the HMO. The highlight of the managed care plans is that these insurance companies manage your choice of health provider. They have a list of doctors and hospitals and only if you restrict your visits to the service providers in the list, then only will the plan cover your medical costs. This is not say, that you have no choice regarding the health provider. Under some managed care health plans, you can visit a doctor of your choice, but the financial benefits provided, you visit a listed doctor, are far greater.
Also, if you opt for the managed care health plan, you will need the nod of approval of a listed doctor, in case you have to visit a specialist. You must also keep in mind that usually there are many alternative ways to a treatment, and if a situation so arises, the general tendency of the insurance providing company would be to settle for the option that is the least expensive.
Fee-for-service plans: These are the traditional health insurance plans, and they are also known as the indemnity plans. They are costlier than the managed care plans, but their major advantage is that you can visit a service provider of your choice. This plan is especially suitable for those who are suffering from an illness and have faith in their own doctor only.
Apart from the above, the state of Texas also provides coverage to pregnant women and people with special disabilities.
There are also the Texas Health Insurance risk pool health coverage plans, which cover families whose income is high enough to exclude them from Medicaid, but at same time not high enough to buy private insurance. In act, the Texas Legislature also provides for two plans to provide health coverage to children between 0 to 19 years. These are the CHIP and children Medicaid program.
The aim of both these programs is to provide health coverage to children in terms of check-ups, immunization, preventive health care, labs tests and doctor visits.
By: Peter Emerson
Posts Tagged ‘Hmo’
Health Insurance 101 Explained
February 2nd, 2010
We all understand the importance of health insurance; however, as the types of health insurance continue to increase it is becoming more and more difficult to select the type of coverage that is best for you and your family. To help you find out which type of policy might benefit you the most, let’s take a look at the most common types of policies.
There is usually a lot of hype regarding HMOs so let’s look at that one first. A HMO is a health maintenance organization plan that works with a specified group of doctors and hospitals within the network. A primary healthcare physician is selected and you must obtain referrals for care that cannot be provided by that physician. The benefits of this type of plan are lower office visit costs and prescription drug co-pays. In addition, there will typically be either no or limited deductible costs for hospital stays. Depending on your coverage, there may also be no pre-existing condition cause limitations. It is also important to understand that your choice of doctors and hospitals will be limited with a HMO and you won’t be able to have out of network services covered.
A PPO or Preferred Provider Organization works similar to a HMO; however, the major difference is that you are not required to select a primary care physician. In addition to the benefit of being free to choose your own physician without worrying about a referral you also gain the benefit of limited or no deductible costs for hospital stays as well as a possible larger selection of physicians that might be available with a HMO. Out of network services may also be covered; however, for a higher charge than in network services.
A POS, or Point of Service, is also similar to a HMO in that you select a primary care physician. The difference is that you are free to choose out of network treatment if you’re willing to pay a higher out of pocket cost.
Another option is what is known as a traditional coverage policy. This type of policy will have a higher monthly premium as well as deductibles. In addition, you will generally be required to pay for services out of your own pocket up front and then submit claim reimbursement forms.
You may also wish to consider various types of disability plans, which cover a percentage of your income in the event that you experience an illness or accident that prevents you from working for a period of time. A short term disability plan will provide benefits from the first day of an accident or the eighth day of an illness up to 26 weeks. Generally, this type of plan will cover 66% of your weekly income.
Long term disability will begin after short term coverage has expired and will provide coverage for a variable term, depending on the policy you select. Some policies are limited to providing coverage up to two years while others will cover you up to the age of 65.
By: Joseph Kenny
