Archive for October, 2009

A Primer on HMO Insurance Plans

Health insurance is such a burden on our budget. We have to pay for it every month or year depending on our plan. When we don’t need to use it, that makes it all the more frustrating since the money we pay goes to waste. On the other hand, if we have an illness that’s too expensive to cure, our health insurance will cover it. That’s the time our annual payment becomes worth it.

But because not everyone will use it in their lifetime, there is now a new option to choose from. Many people complain that they waste a lot of money on health insurance, so to make it cheaper; the HMP health insurance plan was started. This is different in many ways from the traditional health insurance we’re very familiar with.

The HMO or health maintenance organization is a health insurance plan similar to the plan we’re accustomed with. It pays for our medical bills when we go to the doctor or when we need medicine for our illness. However, there’s also a big difference between the two. It’s more affordable but it has its own setbacks.

HMO pays for only a limited number of illnesses. It allows the members to have a primary doctor and hospital who works with the HMO so they will know what sort of prevention to give you. The doctors are connected with the organization into giving you checkups. This way, they will know if you really need treatment. Unlike the traditional plan which makes some people take unnecessary pills, HMO doesn’t have that nonsense. If ever you are ill with something they cannot cover, they can recommend you to something else.

HMO mainly focuses on preventing illnesses, instead of curing it. Also, it doesn’t require you to pay for fees that seem unlikely to happen in the future. For example, it doesn’t cover a disease that comes in one-in-a-million patients, but it probably covers breast and lung cancer, depending on your negotiation.

When you go for a medical service, the doctor and hospital you’re going to should be approved first. Unless they are members of the HMO network, you’ll have to pay for your fees which are pretty expensive. Another thing to know is that when you always go to a doctor, you will have to pay a little something in exchange. You cannot expect to receive all these free unnecessary services anyway.

For me, the advantages and disadvantages of the HMO health insurance plan balances everything out. HMO has the benefit of a lower insurance cost. It also focuses on making preventive measures. They want you to seek out medical services so future expenses can be avoided. This is good for our health, since the chances of our getting sick are slimmer. Another advantage is the unlimited benefit of this lifetime plan. As long as you don’t quit being a member, they will pay for your medical fees.

However, the disadvantages can also be felt. You can only go to the primary care physicians you chose the first time. You can’t seek other help unless it was recommended by your physician and with the approval of the HMO. The problem with this is if your physician doesn’t have the competency of a great doctor. You can find another physician with the approval of the insurance. This could be hard though, and you can only change your doctor probably once or twice in your lifetime. Of course, if you want to seek other opinions, you can but with your own money. The only exception to this is in emergencies. But even with that, your HMO plan has its own definition of an emergency.

Because of the benefits and drawbacks of an HMO plan, you have to analyze carefully which is better for you: the traditional or this option called HMO? What could make this decision easier for you is if you think with these questions in mind. Can you afford to have the regular plan with higher fees and still live comfortably? Is there a chance that I will need the medical needs the HMO plan doesn’t cover? Which is more advantageous to me in the long run?

When you think about the health insurance fees you have to pay, don’t always feel so glum. Just think of how much you will save if your treatment for some disease is covered by the insurance. You don’t have to worry about additional fees unless some complications will occur.

A Primer on PPO Insurance Plans

Most, if not all Americans have some sort of health insurance plan they have to pay regularly. Having insurance covers the costs you otherwise have to pay in full amount. With a health insurance, you can get it for free, at a discount, or you get reimbursed. This is very important since medical bills can be very expensive, especially when you get an operation or something. There are different types of health insurance, one of which is the PPO.

PPO or preferred provider organization health insurance plan is a little different from the traditional plans. It is more like the HMO or health maintenance organization with the fact that it has a network of service providers who can give you the treatments necessary. It includes some hospitals (because some hospitals have higher fees than others), medical labs, and of course a network of physicians. However, the PPO has higher rates than HMO, but less than the regular plans people usually have.

Some insurance plans cover all the medical fees of a patient, no matter how unnecessary it is. You don’t have to pay for anything. However, the PPO doesn’t work like that. You have to pay for the whole medical bill at first, but it will be reimbursed in the end. The deductible depends on the plan you have with the PPO insurance, but usually it would be about 80%. That is if you go to a physician within the approved network. If not, the deductible would probably be about 50%. The change could be great, which is why you have to check with the network before going to a physician.

The PPO plan is a more complex kind of health insurance. There are plenty of advantages with this type of plan. One of the main advantages of PPO is that it gives you more freedom than HMO gives. With the HMO, you can only go to the approved physicians. But with PPO, you can go somewhere else without waiting for the approval of the insurance. This is beneficial when your case needs immediate attention or a special care. But as I said earlier, you have to pay for it first before getting reimbursed after claiming it.

PPO has a large network of physicians to choose from. You just have to choose an insurance company which has lots of connections who are good and at the same time, near your location. Even if you have the choice of going somewhere else, it would be less expensive to get an in-network physician. This is great for those who have rare diseases, since the network is broad. And in case your preferred doctor isn’t included, you can still partly reimburse the costs. PPO doesn’t really require you to choose a primary care physician, since they will still cover the cost anyway.

But with these benefits are disadvantages, one of which is the cost of the insurance plan. The cost of PPO plans is generally much higher than HMO plans, although the latter has a more limited coverage. However, there are several kinds of PPO plans to choose from. The deductible rates differ and the higher deductible, the lower premium you have to pay. You really have the freedom to choose here.

You have to think a great deal about the issues that concern the different types of health insurance plans available today. Which among PPO, HMO, or the regular plans is the best for you in the long run? Don’t just think about your present situation, because an insurance plan usually lasts a lifetime. You’re making a commitment once you’ve decided on one plan. Not doing so could cost you more money.

Also, take note of the money you have and the risks you have of getting sick. Don’t get an expensive insurance if you don’t make that much money. Check your lifestyle too, to see what possible illness you might get in the future. The most important thing is still prevention, but if it’s inevitable, you still need to go to the hospital and having an insurance to back you up is essential.

Insurance is really important today. Some people take it as a burden they have to bear because it’s required by the state. But for others, it’s a way to save money because they can’t afford to pay for the medical bills that are always too high for their own good. To make the most out of your insurance, you have to choose wisely.