Health care is not cheap and if you find yourself in a situation requiring medical attention you don't want to be concerned about the bill. Learning the basics about health care will help you select a plan that fits your needs and provides you with good protection.
This section will cover some basic information regarding plan types and how to select a doctor. The related articles section will provide information on some of the terms related to health insurance and Health Savings Accounts (HSA).
Health Insurance Plans
Health insurance offers a wide variety of options. It pays to take the time to understand each style of plan to be sure you make the best selection.
Managed care plans are designed to help keep costs low. These plans develop a network of approved doctors and by seeing only in-network doctors, you keep costs your low. Managed plans can be broken down into four categories:
HMO - These plans come with low premiums and sometimes no deductibles which can be very advantageous. However, patients are restricted to seeing only certain doctors and the quantity and types of tests allowed are usually also restricted. With an HMO plan you will usually have to select a primary care physician to coordinate your care.
PPO - Similar to the HMO, but more flexible. The network of approved doctors is still in place, but you are able to see out-of-network doctors, though you may have to pay more. With this added flexibility also comes higher premiums and deductibles.
POS - The POS plan is somewhat of a hybrid between the HMO and PPO. With the POS plan you will usually be required to have a primary care physician who will refer you to specialists when needed. You are able to visit out-of-network providers, but your costs are higher if you do so.
EPO - You are still required to use in-network doctors, but there is no need to select a primary care physician or get a referral to see a specialist. A downside is that if you see an out-of-network care provider you may be responsible for all service charges.
Selecting Your Doctor
Not all doctors are created equally and selecting the right doctor can save you time and money. We have provided some information below to help with your selection process.
In-Network vs. Out-of-Network
We previously discussed the types of plans available and one common theme was the doctor network. By selecting a doctor in-network you will have lower costs and get the most out of your insurance plan. As an added bonus, they will process the insurance paperwork for you which is very helpful.
You will be revealing many personal facts to your doctor and, while they are required to maintain confidentiality, you want to be sure you feel comfortable talking with them. Ask family or friends to refer a doctor that they think you will like. You can also turn to sites, such as Healthgrades, to see how other people rate doctors in your area.
This may fall under reputation, but it's important enough to call out separately. In your first meeting with a new doctor an important topic to discuss is their policy on communication and emergencies. Will you be provided with your doctor's personal number/email? If they are unavailable who could you reach in an emergency to get a hold of them? These are important questions and a doctor who is unwilling to provide emergency contact information might not be your best selection.