Bush: Deciding on a health plan
By CARLA Y. BUSH
Each health insurance provider offers different types of plans.
You may get a type of plan called a PPO or Preferred Provider Organization. In this case, your health insurance company will contract with groups of health care providers who agree to provide services at pre-determined cost. The care providers who have agreed to the prices are "within the network." You may still choose "out-of-network" providers, but you will end up paying more. Many people like PPOs because they can often see doctors without referrals from a primary care physician.
A second type of plan is called a POS or Point of Service Plan. This plan is similar to the PPO plan in that there are "in network" and "out of network" providers. The major difference is that in a POS, all specialized care must be coordinated by a primary care doctor and you need a referral from your primary care doctor to access specialized care or services.
An HMO or Health Maintenance Organization usually limits your coverage and care to those doctors and services in the organization, much like a network. In an HMO, however, you may have lower premiums and out of pocket costs.
The Catastrophic Health Plan is designed to provide coverage for unexpected medical expenses above and beyond routine care which is paid out of pocket. Within the Marketplace, catastrophic plans are available only to people under 30 and people who qualify for a hardship exemption. Marketplace catastrophic plans do pay for three primary care visits a year at no cost and some free preventive services.
Health insurance is big news these days. The newcomer to the health insurance options that you now have is the Health Insurance Marketplace created by the federal Affordable Care Act. Your personal insurance may not have been greatly affected by the changes implemented by the act, but you may know people for whom the Health Insurance Marketplace provides new options and choices. We are not here to promote or defend the Affordable Care Act. Whether you have positive or negative feelings about the legislation, you or someone you know may be affected by the provisions of the Act. We are here simply to give you reliable information about insurance so you will be able to make the best choice for you and your family.