Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses.
Insurers use the term “provider” to describe a clinic, hospital, doctor, laboratory, healthcare practitioner, or pharmacy that treats an individual. The “insured” is the owner of the health insurance policy or the person with the health insurance coverage.
Depending on the type of health insurance coverage, either the insured pays costs out of pocket and receives reimbursement, or the insurer makes payments directly to the provider.
It’s good to have choices. When it comes to health insurance, you have your choice of several plan types. Two you’ve probably heard of are a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). Generally speaking, the difference between HMO and PPO plans includes the size of the plan network, ability to see specialists, plan costs, and coverage for out-of-network services.
Let’s take a closer look at each plan type to see how they’re alike, how they differ, and how you can choose the type of plan that meets your needs.
An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO’s network. There are few opportunities to see a non-network provider.
Some other key points about HMOs:
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a higher rate.
Here are some key features:
Also referred to as a catastrophic plans are available under both PPO or HMO plans. These health insurance plans are the least expensive but also provide minimal coverage. They have a high deductible, so they’re not ideal for people who are on regular medical care or frequent the doctor regularly. However, they’re often a perfect fit for young and healthy people who only need insurance in case of a medical emergency or accident, like a burst appendix.
Many people today obtain their health insurance through their employer, but this isn’t always the case. To acquire health insurance if it’s not provided by your workplace, you can purchase it during the annual open enrollment period or mid-year if you experience a qualifying event. You also have the option to purchase coverage directly through a carrier, or if you qualify for a premium tax credit, you can purchase your coverage through a state or federal marketplace.
If you don’t go the doctor often and you’re in good health, health insurance might seem like an unnecessary expense. The thing is that you never know when a health emergency can happen and knowing you have medical insurance can provide peace of mind and an element of financial security.
Carrying a health insurance policy also makes it more likely that you’ll visit the doctor for preventive maintenance and health checkups, which could help you avoid more serious illnesses later. And those illnesses could end up costing you a lot more if the signs aren’t caught early!
And finally, if you do have health insurance, you’re more likely to go to the doctor when you need to instead of putting it off for fear of it being too expensive.
As an independent agency, we have access to multiple carriers. We do all the research and comparison shopping for you, helping you lock in the most competitive prices while getting a plan that best fits your needs. We take a data-driven approach to find the perfect policy so that you have the coverage you need without paying for the things you don’t.
Our easy, do-it-yourself quoting platform provides you with multiple quotes in minutes. Just answer some questions and after a few CLICKS, you can BIND your policy!