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Finding health insurance can be quite a daunting task, and whether you’re getting insurance through an employer or on your own, understanding health insurance policies can seem like a confusing puzzle with many different pieces written in a foreign language.
Regardless, health insurance coverage is extremely important, and so is understanding each aspect of it.
When you’re looking at health insurance, it’s helpful to understand what the differences are between PPO policies and HMO policies. Although these are the main two kinds of health insurance coverage, there are other types of coverage that you can get, and choosing what’s right for you is completely based on an individual’s needs.
If you’re employed, you may be able to obtain coverage through your employer if they offer a group health insurance plan. When you obtain coverage through an employer, either all or at least part of the policy’s premium is paid for by the employer. If group health insurance is not available, then you’ll have to consider an individual insurance plan, with which you’ll be required to pay the entire premium amount.
There are quite a few differences between an HMO (health maintenance organization) policy and a PPO (preferred provider policy) policy. Perhaps the two biggest differences between these two have to do with network and cost.
HMO plans are much more affordable than PPO policies, but they are more limited in coverage. An HMO policy allows the insured to choose a primary physician that’s within a network that the insurance plan chooses, and if any referrals are made by these physicians, they must be within the HMO network of physicians as well. If you go outside of the plan’s network of physicians, then you will end up having to pay more money out of your own pocket.
PPO plans, on the other hand, are usually more expensive but they do allow you to go to physicians within a larger network, so you’re more likely to be able to go to a physician of your choice with a PPO plan. Additionally, PPO plans give you a little more room when it comes to going to physicians you’ve been referred to. While you won’t be covered 100% for this, your insurance policy will have a pre-determined amount that it will pay to assist you a bit.
There is an alternative to both of these plans which are aren’t talked about very often, but a POS (point of service) policy is another option in health insurance. POS insurance policies require you to have a primary health care provider that is in the network as determined by health care providers. Additionally, if your physician refers you to another physician, such as a specialist, you do have the ability to go outside of the insurance plan’s network.
Another important thing to consider when trying to decide between the different types of health insurance policies is what each kind of policy offers for various different coverages. Additionally, you should consider other factors such as if you have children, how often you plan on going to the doctor, what kind of medical issues you or your family has, and what kind of care you think you may need either immediately or in the future. Considering things such as the deductible, which is the amount you have to pay out of pocket before the policy will pay for anything, is one thing to consider, as well as what the co-pay is, which is the amount you’re responsible for paying when receiving medical care.
Only you can decide what kind of insurance is best for you, so talking with a qualified life and health insurance agent is the only way to determine what kind of care will best take care of you. Having health insurance is incredibly important, and should be chosen with care.