Five Popular Health Insurance Questions

Health insurance has certainly been a topic that’s on many people’s minds lately, and rightfully so. Having the right health insurance is imperative, and figuring out what kind of insurance will suit you best is something that only you can decide, however, there are a few questions that most people have when look for health insurance, and they’re questions that should be asked in order to obtain the coverage that’s best for you.

1.) What is a “PPO” policy?

If you’re considering buying a policy that has a PPO factor, then you definitely need to understand what this means. Insurance that uses PPO refers to a health plan that gives you the permission to use a physician that is not only in the insurance company’s approved network of physicians, but you can also visit physicians that are out of network, and it also means you can visit specialists, hospitals, and medical facilities without having to utilize a referral system. It’s more common to find healthcare physicians that accept PPO insurance than it is to find one that accepts HMO insurance plans. Of course, there’s also a difference in the price, and this can depend greatly on whether you have insurance under a group health insurance plan or if you have an individual health insurance plan. If you’re covered under a group insurance plan, you’re typically looking at a higher premium for PPO policies than you are with HMOs. If you have individual health insurance policy, an HMO plan is cheaper than a PPO plan however.

2.)    How do co-payments work?

When you go to a physician, specialist, medical professional, hospital, or other medical facility, then you’ll be responsible for making a co0payment, which is the amount you’re responsible for paying as defined on your health insurance policy, and generally it’s a percentage although it can be a stated amount. Having to make a co-payment is necessary regardless of what you’re visiting a healthcare professional for: whether it’s a simple visit, to have blood work done, for X-rays, and things such as an ER visit or trip to specialist. The amount of a co-pay for different offices, such as a general physician versus a specialist, usually differs and is defined on your insurance policy.

3.)    What is a deductible and how does it work?

Once you’ve chosen a medical plan, you’ll have a wide variety of options to choose from when it comes to a deductible amount. If you understand how auto insurance deductible works, then you already have an understanding of how deductibles work. Typically deductibles range from the lower price of $250 but can go all the way up as $8,000, and this is the amount you’re responsible for paying for medical services you’ve received before the insurance company you have health insurance through will pay for anything. If you haven’t met your deductible amount, then you have to pay the entire medical bill, but it will be 100 percent of what’s called a negotiable rate, which means you’re not paying as though you don’t have insurance, but instead the negotiated rate is listed on your policy and is agreed on by your medical provider and your insurance company.

4.)    When can I stop paying for my medical bills? Is there a limit?

Any kind of health insurance plan you get will have what’s called a Co-pay limit, stop-loss, or maximum out of pocket limit defined on your policy which states the maximum amount that you have to pay out of your own pocket. A majority of the time – the time-frame is defined in a stated time period, such as a calendar year or lifetime. For example, your policy may say that if you have paid for $500,000 towards medical bills, then you won’t be responsible for paying anymore than that and your insurer will pay for the rest for the duration of that stated time period.

5.)    What is an HMO plan?

As opposed to a PPO insurance policy, this kind of insurance assigns you to a specific primary physician that will be the one responsible for your medical needs. A primary physician can refer you to other physicians and specialists as needed, and traditionally, co-pays for an HMO plan are cheaper than on a PPO plan.

Once you understand how health insurance works, you’ll be able to make an informed decision. Talk with your insurance agent to find what works best for you, and also consider how much you’re willing to pay out of pocket and if the plan you choose will allow you to visit your preferred doctor.