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Q1. What is the best health plan for me? |
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Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.
With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and copayments .
In the "Things to Consider" section of the site, there are some excellent guides about choosing and comparing health plans.
Here's a list of key questions to consider in selecting the plan that best meets your needs:
? How much will it cost me on a monthly basis?
? Are there deductibles I must pay before the insurance begins to help cover my costs? After I have met the deductible, what part of my costs are paid by the plan?
? What doctors, hospitals, and other medical providers are part of the plan? Are there enough of the kinds of doctors I want to see?
? Where will I go for care? Are these places near where I work or live?
? If I use doctors outside a plan's network, how much more will I pay to get care?
? Are there any limits to how much I must pay in case of major illness? What about limits and deductibles for certain types of care such as surgery or maternity?
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Q2. How do I compare health plans? |
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You can compare benefits and prices of different plans side by side using the "COMPARE BENEFITS" feature. On "Step 2: Compare Plan Benefits and Prices From Leading Companies", check the box of each plan you want to compare. Then click "COMPARE BENEFITS".
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Q3. What types of health plans are available to me? |
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Health insurance plans usually are described as either indemnity (fee-for-service) or managed care. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans.
Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of health care providers if you select an indemnity-type plan.
Besides indemnity plans, there are three basic types of managed care plans: PPOs, HMOs, and POS plans.
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Q4. What is a PPO? |
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A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.
? If you obtain care from a medical provider outside of the PPO network, you will pay more for the service. For example, a PPO might pay 90 percent of the cost for a visit with an in-network doctor but only 70 percent of the cost for a visit to a non-network doctor.
? You will typically pay a copayment for each visit/service. These copayments are typically higher than an HMO copayment but not always.
? You will usually be responsible for paying an annual deductible.
If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs are likely to be somewhat higher.
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Q5. What is an HMO? |
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An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.
? If you obtain care without your primary care physician's referral or obtain care from a non-network member, you may be responsible for paying the entire bill. (with exceptions for emergency care)
? With some HMOs, you pay nothing when you visit in-network doctors. With other HMOs there may be a small copayment for the visit or service.
? With most HMOs you will not be responsible for paying a deductible.
If you join an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO.
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Q6. What is an office visit copayment? |
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An office visit copayment is a fixed dollar amount or a percentage that you pay for each doctor visit. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your copayment is 10% and the doctor visit was $200, you would pay 10% which, in this case, would be $20.
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Q7. What is a deductible? |
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A deductible is the amount of annual medical expenses that a health plan member must pay before the plan will begin to cover expenses. For example, if your plan has a $500 deductible, you will pay the first $500 of your medical expenses before your health plan begins paying the expenses. Only expenses for covered services apply towards the deductible. For example, if you paid $100 for a visit to a chiropractor but the plan does not consider chiropractic care a covered expense, then the $100 will not apply toward your annual deductible.
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Q8. What is the difference between an in-network and an out-of-network medical provider? |
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An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you visit a doctor within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network doctor. In many cases, the insurance company will not pay anything for services your receive from outside their network; however, there are exception to this.
As a general rule, HMOs tend to have smaller provider networks than PPOs. In HMO and PPO plans, referrals to specialists will be to doctors within the network. Indemnity plans typically do not have networks; you go to whatever doctor you want.
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Q9. Can I buy health insurance for less if I buy directly from the insurance company? |
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No. Insurance companies charge the same premium whether the plan is purchased directly from the company, through a broker, or online
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