What is PPO medical health insurance?
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.
What is point of service medical health insurance?
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.
What is HMO medical health insurance?
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.
What is traditional medical health insurance?
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.
What does all that medical health insurance jargon mean?
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.