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Current Choices in Health Insurance Plans

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Current Choices in Health Insurance Plans

Current Choices in Health Insurance Plans

Choosing a health insurance plan has become more difficult, what with the range of plans on offer. The right plan for your family, employee or group will depend on you own requirements from the health insurance plan. It will also depend on your financial capabilities and the geographical area you are located at. It is important for you to understand that no plan will ever cover 100% of your medical needs. Therefore, you will have to look for the best combination of benefits for yourself.

Basically, all the health insurance plans you get in the market will have one of the following structures-

  • Indemnity or fee for service structures and
  • Managed care

The premiums will depend on the type of policy and benefits you are opting for. You will also need to consider the copayment and coinsurance you have to pay. All these will be explained in the plan benefits details that will be provided to you.

The main difference between an indemnity and managed care program is that you will be limited in your access to healthcare providers and the out of pocket costs you have to pay in case of managed care plans. Indemnity plans let you go to a provider of your choice. However you have to bear a certain percentage of the costs you incur. Managed care programs let you access providers within the network. This results in you paying lower coinsurance for a particular service you have availed of. Indemnity plans on the other hand let you pay for the service, so that you can make a claim later on.

Here is a detailed discussion about the different kinds of health plans that are available in the health insurance market today.

Indemnity plans

This is also called a fee for service plan. This is a plan where you have freedom in choosing the health care provider you want. After availing of his services, you need to file a claim with the insurance company so that your costs are reimbursed. Indemnity plans usually have a deductible level that has to be met before the carrier starts paying for your treatment. Also, they will have a percentage of the amount that they are willing to pay for your treatment. This falls under the ‘usual and customary’ rates applicable.

Managed care health plans

  • PPO - this is close to an indemnity plan. You go to a provider who provides you pre negotiated rates of treatment. You pay a lower copayment and have lesser paperwork. If you go outside the network, you have to first meet a deductible level and pay a percentage of coinsurance.
  • HMO - these offer low co payment amounts and preventive health checks. There are different types of HMOs also. You are allocated a primary care physician who looks after your health. If you feel that you need to go to a specialist, you need to get a referral first. They also account for emergencies where you need to get treatment outside the network.
  • POS - these are point of service plans. They have features of both HMO and PPO plans.
  • HSA - Health Savings Account Plans- these are high deductible plans, which carry a tax advantage. You can get these by depositing the deductible in a tax deferred Health Savings Account.

Apart from these plans, there are also other government sponsored plans like Medicare and Medicaid. Medicare is federally sponsored and is provided to Americans who are over 65 years of age. Medicaid mainly provides covers to people with lower incomes and is applicable to pregnant women and children.


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