My family is very spoiled with our health insurance plan. My husband is in the military so we have never really had to think about choosing a health care plan or how to pay for it. Since my site is meant to serve all moms though, not just those affiliated with the military, I realized I should probably do some research in this area since it’s one that affects so many other families. Here’s what I learned.
Types of Healthcare Plans
- Fee-For-Service: These plans typically cost the most but they also offer you the greatest flexibility in choosing who you want to see.
- Health Maintenance Organizations (HMOs): These plans have lower co-payments and cover more preventative care but they usually have a very limited network of providers from which to choose.
- Preferred Provider Organizations (PPOs): These plans fall between fee-for-service and HMO plans in terms of co-payments and flexibility. In PPOs you can opt to see an out-of-network provider, you’ll just pay more when you do. For an example of a PPO see Blue Advantage of North Carolina
- Point-of-Service (POS): These plans are similar to PPOs but you must choose a primary care physician from within the network and get a referral from him or her before seeing anyone outside the network or a specialist.
Questions to Ask
- What does the plan cover? – Health reform has made it mandatory for insurance sold to individuals and small business to cover the same 10 “essential health benefits” so no matter what plan you choose, you will be covered for all of the key areas of concern from mental health and substance-abuse treatment to preventive services. These same rules do not apply to insurance provided by big businesses, so if you work for a large company, you need to get a copy of the Summary of Benefits and Coverage in order to compare it to other insurance.
- How much does it cost? – The new metal tiered plans (bronze, silver, gold, and platinum) help you distinguish between plans that have the lowest premiums and thus, cover less of the health care costs (bronze and silver) and plans that have higher premiums but cover a larger percentage of health care costs (gold and platinum). If you have an expensive medical condition, you might opt for higher premiums so that you will pay less in deductibles and copays when you receive treatment.
- Who can you see? – If you want to see a specific doctor, you will have to find a health insurance plan that includes him or her in its network of providers. Likewise, if you prefer to pick up your prescriptions at the drug store around the corner, you might want to confirm that it is included in the network.