Margret Adams, BSN
Shopping for health insurance can be confusing, so it is important to understand the terminology whether you are choosing insurance as a Medicare or Medicaid recipient, or as offered by an employer.
Most insurance plans are Managed Care plans. Meaning they try to keep the cost down without sacrificing the quality of care. The two types of Managed Care plans are: HMO’s (Health Maintenance Organizations) and PPO’s (Preferred Provider Organizations. The differences between the two are cost, size of the plan’s network, availability of specialists, and coverage for out of network services. “Network” refers to a group of providers (doctors) within the insurance plan.
Out-of-Pocket Costs should always be considered. These costs include the premium you pay monthly, along with the type of deductible (which is the amount you must pay before insurance kicks in.) Choosing higher deductibles can mean lower premium costs, co-payments (the portion you are required to pay) and maximums (maximum dollar amount you pay before the insurance company pays 100%.)
Another thing to consider is where you live. Insurance companies do not offer their products to all communities. Insurance companies are looking to lower their risk, therefore if a community is rated to have higher chronic health problems, premiums may be higher, or insurance may not be offered at all.
It’s important to take your current and future health care needs into consideration when choosing coverage, along with your primary care provider, any specialist you must see, and what prescription medication you take. Other benefits to be considered are dental, vision, rehab, physical and occupational therapy, podiatry especially for diabetics, and for transportation. Employees should be aware of “Wellness” programs that track health outcomes and can affect the premiums you have to pay.
The more you understand your healthcare needs, choosing from the health insurances being offered becomes less confusing. Most plans are offered on a yearly basis, so if you need to change coverage plans you can do so during the open enrollment period.
Information taken from “The Street” article by Terin Miller 4/24/2019