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How Do You Take Your Healing? Choosing Between Health Insurance Plans

Since health insurance plans are available in such a wide variety of forms these days, choosing the right type of coverage can be almost as daunting as finding health insurance in the first place. Should you opt for an individual health insurance plan or group health insurance coverage? Does a fee-per-service plan fit your needs best, or should you opt for managed care? And if you choose managed care, is a PPO or HMO more your style? For answers to all of the above, and more, read on.

Group Health Insurance vs. Individual Health Insurance Plans

For starters, most Americans fall into two categories: those who qualify for a group health care plan, and those who need to seek out health insurance individually. To make a long story short, if you qualify for a group health insurance plan through an employer, a professional or trade association, a religious organization, or any other group, that’s probably your best option. Group health plans mean guaranteed money for insurance providers, and in turn the rates and coverages offered are tough to match. If your group health plan does not meet your health insurance needs, however, or if you’re on your own where health insurance is concerned, then individual health insurance is the way to go.

Getting to Know Individual (and Group) Health Insurance Plans

If individual health insurance is the best answer for your health insurance needs, then the next step is selecting the type of health care plan that’s going to provide you with the coverage you need at rates you can afford (for the record, most of this applies to members of a group health plan, as well). Here are the three most common health insurance plans on the market, and what you need to know about them:

  • Fee-for-Service —Fee-for-service plans allow you the greatest freedom in choosing your health care professionals, though that freedom comes at a higher price than you’ll pay for other health insurance plans. Since many fee-for-service plans also require you to pay for expenses up-front, and then submit your receipt/bill for reimbursement, these plans also require more diligence and organization on behalf of the insured than other options.
  • Health Management Organization (HMO) —Health management organizations (HMOs) operate on a simple principle: by strictly managing your health care needs, and eliminating unnecessary medical visits and procedures, it’s possible to significantly lower the cost of health care. That being the case, in an HMO you will have a primary care physician who determines your health care needs, and who issues referrals to specialists who are also affiliates of the HMO. Members of HMO’s usually have to pay co-pay for each doctor’s visit in addition to a low monthly premium. The catch: if you see a physician who is not an affiliate of the HMO, or is out of the HMO’s operating area, expect to pay most, if not all, of your expenses out-of-pocket.
  • Preferred Provider Organization (PPO) —PPO’s differ from HMO’s in that they don’t require members to maintain a primary care physician, and they eliminate the need to obtain a referral before seeing a specialist. They are still a form of managed care, however, as you must see physicians who belong to the PPO network if you want to receive full benefits. Since PPO’s offer more freedom than an HMO, the monthly premiums are generally higher. However, once you meet your annual deductible, PPOs usually pay for nearly all of your health care costs.

Finding Providers for Individual Health Insurance Plans

Of course, choosing the type of health insurance plan you want is the easy part. Finding a provider to issue you that plan, and at a price you can afford, is another ballgame altogether. Fortunately there are resources available to those on the hunt for health insurance plans that allow you to kill two birds with one stone. Online insurance quote services like specialize in the business of linking consumers to insurance providers, free of charge. And since you’ll get a list of quotes from potential providers, you’ll be able to compare different plans, rates, coverages, and restrictions on the way to finding the best health insurance plan possible for you and yours.

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