Healthcare plans are created to help citizens have access to affordable services that will guarantee a better quality of life. There are many healthcare options available including HMO, POS, HDHP, and so on.
The kind of plan you sign up for is primarily determined by your present or future needs, your available resources, and the kind of health service you need. An HMO or health management organization is an insurance health care plan that allows you to get healthcare coverage with doctors who are registered with the organization. To be eligible, an HMO may require you to live or work in its service area.
But Why HMOs?
Most people like HMOs because of the low premium and because they are highly committed to providing integrated care, and focused on wellness and disease prevention. Enrolling in an HMO is pretty simple. If you worked with an organization, they most likely have a provider which you can sign up with under their staff model program. There are also group model and network model HMO that offer significant benefits.
The Point Of Service Plan
Point of service plan or POS is a healthcare service offered for people who want to enjoy the benefits of HMO and PPO or preferred provider organization, at the same time. POS requires that you sign up with a primary care provider and you will need a referral to see a specialist. But unlike HMO, you have the chance to make use of doctors, hospitals, and other providers who are not in your network. Just like HMO, enroll in this plan in your workplace or buy it on your own.
Preferred Provider Organization (PPO)
A PPO health plan is a managed care system that gives you access to healthcare options and providers like doctors, and hospitals who have agreed to offer health services at a reduced cost. With a PPO you do not need to choose a primary care provider, and you do not need a referral if you require special care. Since they offer more regarding flexibility and choice, PPOs are more expensive and charge higher premiums. This option is more suitable for people who don’t have any issues with costs and could afford more expensive health care.
What is a High-Deductible Health Plan
HDHP is a healthcare plan created to help provide service for people who want to benefit from lower premiums and higher deductibles. People who want to open a Health Savings Account or HSA are required to have an HDHP account. The HDHP works by forcing individuals to become more conscious of medical expenses so that they can lower health care costs. The high deductible in the HDHP helps to reduce insurance premiums which have helped to make health coverage more affordable. You can enroll or HDHP as an individual, as a family, or under the organization, you work for.
Understanding How a Health Savings Account Helps You
You can also sign up for a health saving account if you have an HDHP. HSA healthcare enrolling offer triple tax benefits and can grow from year to year. With an HSA, you can pay for prior year medical expenses, use it as retirement benefits, and use it to pay for Medicare and COBRA premiums. You can enroll in HSA with banks that offer the service. Getting a health care plan that will cater to your needs and that of your family is not an easy task. You need to consider the cost and figure out how you’re going to fund it. Most people prefer HMO health care plans because it is low cost and gives them coverage in many ways. Take advantage of the tax benefits of HSA and the lower premiums of HDHP. Ensure that the most important health issues you encounter are covered by any plans you sign up with.
Exclusive Provider Organization (EPOs)
EPO is a hybrid of an HMO and a PPO. The enrollees are free to choose healthcare providers, just like in PPO plans. Additionally, it is not necessary for enrollees to get referred by a primary care provider to see a specialist. The EPO combines HMO and PPO plans in the sense that it will only cover the enrollees for providers within the organization’s network. They will have to dig deeper into their pockets to get the services of providers who are outside the network unless it is an emergency situation. This plan targets those who are looking to cut down on budget and pay less costly premiums. In this plan, premiums are cheaper than the ones for a PPO but are more costly than an HMO. Usually, EPOs are usually provided by the same companies that provide PPOs. Policyholders pay premiums as well as deductibles. In addition, they copay at the doctor’s office as well as pharmacy, co-insurance as well as other expense that is outside the network.
This is one of the Healthcare Options that are pocket-friendly since the policyholders pay lower premiums. However, they come with higher deductibles. They are specifically designed to cover catastrophic events such as stroke, heart attack, serious car accident injuries and so on, a fact that makes it unique. Under this policy, you have to pay for all out-of-pocket expenses until they reach their deductible. The expenses include office visits, prescriptions as well as any other urgent care expensive. This doesn’t mean the enrollee will pay the full-market value though. They only pay the amount they have negotiated with the company as well as the provider. After the deductible requirements have been met, you are covered for all emergency care medical expenses except prescription expenses because they don’t count towards the deductible. Depending on the insurance company involved, the first few primary care physician visits are free and therefore, they are not subject to the deductible. Additionally, preventive care is not subject to the deductible, although, it varies with healthcare laws. The policies of these healthcare options vary and therefore, it is important to check the type of policy you are going to be given prior to entering into a contract. In line with that, you should inquire about physicians in your area who are within the network. Also, it is prudent to find out about the company’s rules related to specialists as well as if you can visit one without a referral from a PCP. Enrollees are required to pay monthly premiums, their deductible as well as the full cost of any medications and prescriptions they take. In 2017, the deductible for an individual was $7, 150 as well as $14,300 for the whole family. It is very important for you to be keen on your medical expenses and keep the receipts before meeting the deductible just in case the company’s records differ from your own.
Supplemental Insurance Plan
This plan supplements your primary health insurance plan and therefore, take care of costs that are not covered by the primary plan. It can be taken by seniors in Medicare as well as individuals who are looking for additional healthcare coverage. Supplemental health insurance can stand on its own and therefore, it must be combined with a primary plan. You can use it to cover what is not included in major health plans including vision and dental. For instance, you can take a health insurance cover that will see you pay a lump sum if you get admitted to a hospital.
What Are The Plans Employers Can Offer?
The type of health insurance plan that an employer can offer you depends on the company’s workforce, as well as what the company can afford. Additionally, the affordability is dependent on past claim history, healthcare enrollment as well as the company’s budget. HDHPs have become a common plan for employers. According to research, 29% of employees were enrolled in HDHP in the year 2016, a remarkable increase from the previous year. This can be attributed to the relatively low cost of HDHPs. Having said that, many employers who offer HDHPs to their employees also provide a more traditional plan to employees with frequent medical care needs. This also offers some element of choice which is liked by many employees. In the pursuit of a more suitable plan, employers can offer a combination of two plans such as HDHP and PPO. However, the American workforce is very diverse and health plan preferences differ with different people. Other companies consider the option of a second HDHP in combination with a different kind of deductible or another kind of health plan structure such as POS HDHP.
What Type Of Healthcare Plan Is The Best?
Selecting a health insurance plan can be an uphill task. It will majorly depend on your individual needs. If you have a chronic illness you will need a comprehensive health care plan. You can go with the HDHP plan if you don’t need medical care frequently. HDHP plan has registered a huge healthcare enrollment this year. In case you’re an employer and you want your employees to keep their PCPs, you will need a plan which covers a wider network such as POS or PPO plans. On the other hand, HMO is more suitable for employees without a PCP. At the end of the day, a company will strike a balance between their employees’ needs and preferences and the employer’s cultural fit as well as the financial factors when deciding on which type of health insurance the company should offer.