Reader question:

What is PPO medical health insurance?

Jose

Great question.

PPO medical health insurance, also known as preferred provider organization, is one of the strictest forms of medical health insurance plans out there. The other options are the traditional indemnity health insurance plan, which is most flexible; the HMO health insurance plan, which is stricter but not very much; and the POS medical health insurance plan, which is a mixture of the two that ends up being somewhere in between. Standing by itself on a different part of the stage is the PPO medical health insurance plan, which has similarities to the other three, but is all its own.

The very good thing about PPO medical health insurance is that it is cheap. That is the thing that keeps the people it insures within its plan. The cheap premiums and decent co-payments convince people to stay within the network and continue receiving their health care insurance through the PPO medical health insurance plan.

The Good:

• The co-payments are very, very cheap. And I mean very. If you just go for a regular check up, you’re probably going to end up paying your doctor a co-payment of no more than ten little dollars.
• You don’t have to get a referral to go see a specialist. That isn’t an open ended invitation, though. In order to be covered by the policy when go to said specialist, he has to be a part of the PPO network.

The Bad:

• You can go outside of the network to see a different physician, but the coverage doesn’t extend quite as much, and you’ll have to pay for the visit at the time and then send in a health insurance claim to be reimbursed once you get the bill.
• If you do go outside the network, that’s where the deductible comes in. You’ll probably have to pay one, and it’s also true that if the physician that you visit costs more than the ones within the network, you won’t be reimbursed for the difference.

Cheers,

Fashun Guadarrama.

Reader question:

What is point of service medical health insurance?

Maggie

Great question.

A point of service medical health insurance program is kind of like a mix of both traditional indemnity insurance and health maintenance organization insurance. It has some of the qualities and cons of both, and while it has some of the flexibility of the traditional indemnity plan, it also contains the requirement of the HMO plan that you must pick a primary care provider and go only to them without a very good excuse. It’s like being both free yet organized if you pick a point of service medical health insurance plan.

If you have a point of service medical health insurance plan, then you have to choose your primary health care provider and hospital from a network chosen by the health insurance company. This isn’t a strict arrangement. If you go to a physician or hospital within the network, then you will be covered or have to make a co-payment in order to be treated for your sickness or injured part. But there is also the option of choosing a physician or hospital outside of the network to go to. If you do this, you must then file a claim with your POS.

The Good:

• Most of the point of service medical health insurance plan allow you to receive your health care outside of the network that they provide. This sounds nice and flexible at first, but it has its drawbacks. While you can get good coverage within the network, it drastically decreases once you move outside of it.
• Point of service health insurance plans are very good on things like preventive medicine and services. Not only are you covered for things like pap smears, but you even get things like cheaper rates for gyms and classes to help quit smoking.

The Bad:

• Like in an HMO, point of service medical health insurance plans require that you choose a primary health care provider, and you are then required to use that provider if you want the best rates.
• Yes, you are allowed to go outside of the network to see a doctor or specialist, but that doesn’t mean that it will be easy to get covered. If you do it without a referral from your primary health care provider, then you have to send in the bills all by yourself and might not get a check back at all, and if you do it will be a small one.

Cheers,

Fashun Guadarrama.

Reader question:

What is HMO medical health insurance?

Miriam

I’ll tell you.

The main benefit of getting an HMO, or health maintenance organization medical health insurance plan, is that this most popular of employer provided health insurance plans also tends to be the cheapest medical health insurance plan. It’s more designed for group health insurance, which is why it finds such popularity among companies insuring their employees. HMO medical health insurance is also one of the few health insurance plans that puts a lot of emphasis on preventive care.

The reason they put so much emphasis on preventive care is because, the way HMO sees it, is that preventive care can help reduce risks in an insurance pool by decreasing the likelihood that its members will develop a medical conditions, and thus it reduces medical costs. That is why it is the best to help someone stay healthy, not just to help them out if something goes terribly wrong.

The Good:

• The main thing is preventive care, which lowers both their costs and yours. HMOs also require less paperwork, and when you make a co-payment on something it will cost far less than it would with another medical health insurance plan.
• The insured under a health maintenance organization just pay a little fee each time they go to the doctor, and that is considered their co-payment.
• The coverage goes wide, with such things as outpatient services, extended medical treatment, short term mental health treatment, hospital stays, and emergency room visits.

The Bad:

• Picking and choosing the physician that you go to isn’t as easy as with traditional indemnity. Instead, you are only able to pick one provider, and that is who you must go to once he is listed on your insurance.
• The doctor you must pick has to be within the HMOs network. If you go to a hospital or physician outside of the network, then you won’t be covered at all.
• If you want to go outside of the network to see a specialist and still be covered, then you have to have a referral from your primary care provider.

Cheers,

Fashun Guadarrama.

If you want to get traditional indemnity medical health insurance, also called FFS or fee for service medical health insurance, then you’re going to have to like paperwork. That’s why I’m including this video of a cute baby kitty in this post. Because, naturally, thinking of adorable kittens makes any distasteful action funner. Well, that might be overselling it a little bit.

Regardless of the extra amount of paperwork required, fee for service medical health insurance isn’t all that bad. It does cost more, with both more pricey monthly premiums as well as deductibles that tend to be on the high end, but at the same time it is a lot more flexible than many kinds of medical health insurance plans. If you’re willing to pay a little extra money and spend a little extra time for a lot more freedom and choice, then traditional indemnity medical health insurance might be the best option for you.

The Good:

• Lots of flexibility, in that you can pick what doctor, specialist, or hospital you patronize instead of having to choose out of a network and having to get a referral to go outside that network. It helps you take control of your medical experience and handle the way your health is going more than other, more controlling plans.
• No referrals, again. If you have to go to a specialist, you don’t have to worry about getting denied by the primary care giver that your insurance company picked for you. You can choose on your own.

The Bad:

• If you want the medical health insurance company to pay for the health insurance claim, you have to pay the deductible first, and this often is high. Also, after you have paid the deductible, you usually have to co-pay. Although the insurance company tends to pay around eighty percent, you still have to pay the other twenty.
• Your medical health insurance doesn’t cover your needs right away. Rather, you have to pay first and then file a health insurance claim to get your money (most of it) back to you.
• Traditional indemnity medical health insurance decides what is the normal price for a medical service, so if you go to a physician that is more expensive than others around the same area, then you’ll have to pay that extra money because the insurance won’t cover it.

Cheers,

Fashun Guadarrama.

Say you’re going to be traveling to a country where English isn’t the official language. If you want to be understood and to understand, and don’t want to be completely confused while you’re over there, the least you want to do is learn a few key phrases, right? You might not be able to become fluent in the language over night–that only comes with experience–but to a certain degree you can at least be able to get by and not be lost in a such a foreign place.

The same basic principle applies to medical health insurance. These medical health insurance policies often come full of crazy jargon that is not explained and that you don’t understand, and so it makes choosing a health insurance plan difficult because you don’t understand what it means. There are many kinds of medical health insurance, such as:

• FFS, which means indemnity fee for service.
• HMO, which means health maintenance organization
• POS, which means point of service
• PPO, which means preferred provider organization

All of these plans is very unique and individual, and you should consider all of its features before you make a decision on what kind of medical health insurance plan that you want. The last three are considered to be more managed, and the care for yourself and your family is more organized, although it is also more restrictive.

Cheers,

Fashun Guadarrama.

Reader question:

I can’t pay for an individual medical health insurance plan! What do I do?

Greg

I’ll help you.

There are a lot of reasons that somebody might not be able to afford individual medical health insurance coverage. Sometimes, if you are a student in college, you might have recently been dropped from your parents’ health insurance plan and, busy with school and having only a part time job, might find it difficult to pay for your own. If you find yourself in this situation you should see what kind of deals your college has to offer when it comes to health insurance.

Even if you aren’t a student, there is something there to help you. A lot of federal programs exist that can either provide someone with medical health insurance or help them to get it, so long as you are eligible.

• Medicaid. This is for people who have a low income and are pregnant, or for their children. It does not cover the adult, though, unless they are pregnant, so if you have children but are also looking for health insurance for yourself, this won’t provide all that you need.
• Medicare. This is most often used for people who are sixty five and up and people who have disabilities that make it difficult for them to get work and provide for their own medical health insurance. It also provides for people who are in the later stages of renal disease.
• Children’s Health Insurance Program. This covers the gap between Medicaid and actually being able to afford health insurance on your own. You have to make a very low income to qualify for Medicaid, and if you make more than the eligibility mark but still can’t handle the high medical health insurance costs, CHIP can help. Again, though, it only provides for children.

A lot of states have their own plans that help children with parents who can’t afford medical health insurance get insured. This doesn’t help the parent, but there are some states that do extend this coverage to insure the parent of said children as well, although not very many states do this.

Cheers,

Fashun Guadarrama.

Reader question:

Are medical health insurance prices ever going to go down?

Amber

Probably not.

The system kind of works against itself. Medical care costs a lot, and people need medical health insurance companies to help them pay for it. At the same time, though, medical health insurance drives up medical bill costs, and it just keeps on chasing itself around in a circle. Circles don’t end, so the likelihood that medical health insurance or health care costs will go down anytime in the near future short of a miracle is very unlikely.

The most important thing to do when looking for a medical health insurance plan is to shop around and compare quotes from different companies. This can often be done on the internet, where quote comparison sites save you a lot of time and money by comparing quotes from several different companies.

Still, once you get a quote and take out a medical health insurance policy, don’t expect that you will be paying the same forever. Insurance companies do everything they can to charge more money, and in many states its very easy to increase prices without any pre-approval. Often, a health insurance company can just send in a request to increase rates and they can immediately start charging those increased rates without an answer, and can only be stopped if they are reviewed and it’s decided that they charge too much.

Your rates could go up even if you don’t make any health insurance claims and are part of a group health insurance plan. The reason this could happen is that somebody else in your group may be making health insurance plans, and then the rates will raise for everybody, no matter in what good health you are. Rates in group health insurance are decided by the group’s total average history, not your individual claim history.

Cheers,

Fashun Guadarrama.

Reader question:

How much does individual medical health insurance tend to cost, and what affects those rates?

Mandy

Good question.

There are many states who mandate that individual health insurance companies insure anybody who wants to be insured and can pay, but this isn’t true everywhere, and there also isn’t a set amount of what you will be paying. Most of the time, it will be a lot. Individual medical health insurance is very pricey, and it all depends on who you are, what your history is, and where you are at. Group plans are a lot cheaper because the number of people dilutes the risks of others in the group and it ends up averaging out, whereas for individual health insurance it’s always concentrated in one person.

An individual medical health insurance plan is usually underwritten so the health insurance company can judge your rates based on your medical history. There are a lot of things that can affect your rates in the end, even things that you wouldn’t think would affect it, such as having been pregnant at some point. Those things can be the difference between high prices and middling ones, being insured and being uninsured.

Individual medical health insurance coverage comes with much the same coverage as group medical health insurance coverage, except for the requirement of individual coverage that it be underwritten. Here are some factors considered by the underwriter:

• Age. If you’re over the age of sixty five, you might be out of luck when it comes to getting medical health insurance. Age is a big factor in who is or is nor eligible for medical health insurance.
• Sex. Benefits of your gender depend on how old you are. When people are longer, females tend to get injured more often and file more health insurance claims than males. Once they turn sixty, it’s vice verce.
• Health History and Physical Condition. Things like pre-existing conditions can make it hard to get decent medical health insuranc coverage. You might luck out and be able to get a different, more limited kind of coverage, but it’s often the case that you will be denied coverage completely.
• Job and Hobbies. What you do in your work and spare time may be more dangerous than what other people do and could result in higher rates or denial of coverage. If you like sky diving or work in construction, you might have trouble getting decent medical health insurance rates.

Cheers,

Fashun Guadarrama.

Reader question:

Are employers required to provide medical health insurance to their employees?

Alma

Quick answer: No.

I’m sorry to say, but there’s no law on the books that says tha employers, or anybody else, has to provide you with medical health insurance. It would be nice, and there are many people who want for the government to provide health insurance for everybody, but that is a very unlikely possibility in this country, and for the meantime you either have to find an employer who does provide you with medical health insurance, or get your medical health insurance on your own.

There are a whole lot of reasons for why employers are not mandated to provide their employees with medical health insurance, but it is a long list and not worth getting into. However, many employers do, mostly because it is a good practice for a business who wants to acquire high level and loyal employees. You are less likely to up and leave a job that is paying your medical bills if you don’t have a job that offers similar options lined up, are you?

Although it’s not smart to do that, though, some people do. If you quit the company you are working for, and you had medical health insurance there, they have no requirement to continue your coverage once you’re gone. Some might be nice and do so, but it’s rare. You need to have something lined up right away or be prepared for a possible disaster.

Now, if you get laid off, you might be able to continue your old job’s benefits for up to thirty six months via COBRA (Consolidated Omnibus Reconciliation Act), but those premiums tend to cost a lot. You can check your laws locally to see if you are eligible for COBRA medical health insurance.

Another way that you can get some help from the federal government if you lose your job and it provided you with health insurance is to see if the Health Insurance Portability and Accountability Act applies to you. This might help if there is only a temporary gap in your coverage.

Cheers,

Fashun Guadarrama.

Reader question:

Who can get temporary health insurance?

Mark

Great question.

One of the reasons that short term health insurance is able to offer its policies at such low monthly prices is because it has much stricter limits on who can be covered under one of its medical health insurance plans. It creates a stricter requirement, and thus those that purchase a short term health insurance plan are part of a pool that has less risk, and with less risk come fewer health insurance claims, and with fewer health insurance claims come cheaper rates.

Usually you can’t get short term health insurance if you are over the age of sixty five. More problems that are similar to the amount of pre-existing conditions come with older age, so short term health insurance companies don’t want to cover people who have the higher risk of getting sick or injured more often. It’s also true that if you applied for a health insurance policy before and were denied, you might not be able to get a temporary health insurance policy.

If you already have a health insurance policy that covers you, even if it’s coverage is very limited, you probably won’t be able to get short term health insurance to pick up the slack. Temporary health insurance plans have several requirements, and you’ll probably have to be within a certain height and weight range in order to qualify. It’s also true that there are several questions that you will be asked about your health history that you will have to answer correctly in order to be allowed to take out a short term health insurance policy.

Cheers,

Fashun Guadarrama.