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How do you choose the best health insurance policy? The answer really depends on your situation in life. Someone who is young and single is going to have far different needs than someone who is older and has a family depending on the health insurance. If you are shopping for health insurance plans, here are some of the considerations you need to make.

HMO, PPO, or POS

One of the first choices you may need to make is which structure your health insurance policy will have. The three most common are HMOs, PPOs, and POSs. An HMO, or health maintenance organization, is probably the most affordable option. However, you will have many limitations with an HMO as to which doctors you can visit, and there is often a lot of paperwork you must go through in order to obtain certain medical procedures or get a visit with a specialist. In an HMO, your doctor is paid a set fee each month for each patient under his care, regardless of whether or not a particular patient receives care that month. You are required to visit doctors who are in the HMO.

With a point-of-service, or POS, your insurance provider only pays when you receive services. You have fewer limitations as to the doctors you can see, but you may be required to pay a portion of the cost each time you receive care. You will have slightly more flexibility if you need specialist care under a POS plan.

A PPO, or preferred-provider-organization, is like a combination of the two previous policies. Like an HMO, you are going to be better off if you choose a physician that is part of your network. With a PPO, your insurance will pay more for your care if the provider is in the network. However, unlike an HMO, you can choose to go to a doctor who is out of the network, you will just have to pay more out of pocket to do so. You will also have a deductible and co-pays with this type of insurance.

Deductible Vs. Premium

The deductible, or the amount you must pay out of pocket before your insurance will kick in, directly affects the amount you pay for your premium. The higher your deductible, the lower your premium will be. However, finding the right balance between the two is not always easy.

If you are going to be using your insurance regularly, such as if someone in your home has a pre-existing medical condition or if you have children who need regular checkups, you may want to pay a little more for your Insurance premium in order to have a lower deductible. However, if your insurance is to be used for potential major health problems that you might face someday, but right now you are relatively healthy, a higher deductible in return for a lower premium may be more beneficial.

Look at Prescription Drug Coverage

Not all insurance policies have prescription drug coverage. The best health insurance policies will cover your prescriptions. If the policy does not cover prescriptions, find out if it offers a discount plan you can use towards drug expenses.

Look at Lifetime Maximum Benefits

Many insurance products will put a cap on the amount you can receive in benefits. This is called a maximum lifetime benefit. These will apply to individual treatments, such as cancer, mental illness, or organ transplants. If the insurance has very low caps, such as $100,000, you need to find something else. Medical expenses add up quickly, and you do not want to be paying for coverage that is not going to be sufficient if you have a severe medical problem in the future.

Choosing health insurance is never easy. Be sure that you work with a qualified agent who can answer all of your questions. Pose various scenarios to see how the insurance would cover situations that could occur in your future. This will help you choose the best Health Insurance for your family’s needs.

Amy Nutt
http://www.articlesbase.com/finance-articles/how-do-you-choose-the-right-health-insurance-746410.html

7 Responses to “How Do You Choose the Right Health Insurance?”

  • grandmasterlau says:

    Please help me choose the right health insurance?
    I am in the process of choosing a health insurance plan at work.

    These two options are what I am considering:
    Anthem POS High Option – $42.00
    Aetna HMO – Ohio(EPO) – $36.00

    The HMO seems to have better benefits (100% coverage after $250 copayment vs 90$ coverage after $250 copayment for hospital coverage, 100% coinsurance percentage vs 90%, both have no annual deductible for in-network). The HMO option also has no annual out of pocket maximum while the POS high potion has a $1200 annual OOP maximum.

    Why is it that the HMO seems to have better options but costs less than the POS high option?

  • Brandi F says:

    Health insurance is tricky…trust me I verify benefits for a living! The bad thing about the HMO is you have to have a referral for every single thing except well woman/man visits. And I mean everything, if no you will get billed for it and it will be a large bill. But with the POS once you meet that 1200 OOP cost it will then pay at 100% and you dont need a referral. (Most of the time you’ll only need a referral to a certain facility not for specific tests, appts etc.) A good way to go is to pick one this year and if you dont like it try the other one next year. Each one has good and bad sides so its your preference.
    References :
    I verify insurance benefits for a hospital

  • Nick W says:

    Plans will vary geatly based on the options and how many providers are in the network. Some have specific extra costs for out-of-network doctor coverage as well as referrals.

    Sometimes, an employer will cover a portion of a healthcare plan and make it available to employees at a discount.

    You should evaluate your overall health and decide which plan is right for your particular situation.
    References :

  • Zarnev says:

    With the HMO not only do you need a referal to see a specialist but you also need pre-approval from the insurance company before you receive almost any medical care. You must use a doctor or hospital in the network. If you travel outside of your area you may have a hard time finding someone.

    The annual out of pocket maximum is actually a good thing. That is the most you will spend during a year for your health care. If you look at the summary of benefits you’ll see that even though the HMO is at 100% you still have co-pays to pay for every procedure. These co-pays can add up to well over $1200 if you have major health problems.
    References :
    Independent Agent

  • mitua s says:

    please try this
    <a href="http://www.jdoqocy.com/click-1748196-10425138" target="_top">help!</a>
    References :

  • kmileameriplan says:

    I would suggest getting something like a discount program instead of insurance or to use on top of insurance. I use one that is awesome it covers my whole household and is very affordable, about $39.95 a month for all of this
    Dental
    Vision
    Coast to Coast
    Amerisight
    Prescription
    Medco
    EZ Meds
    Chiropractic

    Physicians
    Primary Care
    Specialty
    Hospital Advocacy
    Mental Health
    Let’s Talk Counseling
    several ntwk providers
    NurseLine

    Wellness Program
    Infuse
    Ancillary & Elective Services
    Epic
    Hear PO
    AHAA
    Cosmetic Surgery
    Diabetic Supplies
    Diagnostic Imaging Radiology
    Physical Therapy
    Astrum Hearing
    Medstat

    If you want more info on it you can go to
    http://www.mybenefitsplus.com/kmile

    I hope this helps!
    References :

  • book writer says:

    POS, covers meds too
    References :

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