Hopefully you have taken the time to look at part one of this blog (Insert link). Knowing terms like deductible, co-insurance, out-of-pocket max and co-payment are just a start to terms you may encounter. Once again, if you are reviewing a policy and come across terms you do not understand that aren’t covered here, you can reference https://www.healthcare.gov/glossary/. We want you to have the best policy for your individual circumstances.
Premium
I probably should have started with this, but better late than never. Your premium is your monthly cost for your particular insurance plan. This is required whether you use it or not. With each company they will have different “Metal Tiers” to choose from. You can choose from Bronze, Silver, Gold, and Platinum. Your Bronze plans will be the lowest premium costs, but highest out of pocket costs. Platinum will be the highest premium per month, but best coverage. Depending on your medical history and need for care, can help you decide which is best for you. If you rarely go to the doctor, having a Bronze plan may be the right choice for you.
In-Network vs. Out-of-Network
This may be familiar to you, but the repercussions of it may not be. In-network means that the providers (health care professional, hospital, pharmacy etc) have a contract with the insurance company. This usually means a lower cost to you. You may want to check to see if your favorite doctor had a contract before signing up, though things can change through the years.
Out of network on the flip side means that the provider dies not have a contract. This can mean that they aren’t covered, or you may have a whole other deductible and requirements you have to meet for your out of network use.
HMO
HMO stands for Health Maintenance Organization. https://www.wpshealth.com/resources/customer-resources/health-insurance-terminology.shtml Defines it as “a health care financing and delivery system that provides comprehensive health care services for enrollees in a particular geographic area. HMOs require the use of specific, in-network plan providers.”
What this boils down to is that you usually have a lower cost, but you have less flexibility. You will usually have to pick a primary care physician (PCP) and get a referral to specialists. Sometimes there will be some type of coverage for out of network, but you would definitely want to get pre-approval. HMO’s usually have great coverage for preventative services.
PPO
PPO stands for Preferred Provider Organization. It is defined as, “a health insurance plan that offers greater freedom of choice than HMO (health maintenance organization) plans. Customers with PPOs are free to receive care from both in-network or out-of-network (non-preferred) providers but will receive the highest level of benefits when they use providers inside the network,” by WPS health.
To sum that up, you can see who you want to see, but get the best bang for the buck by using in network providers. You also do not need to designate a PCP and can see specialists as needed.
Supplemental Health Insurance
With high premium and high out of pocket costs of plans, many may be looking at something extra to help cover them. Supplemental health insurance could help reduce your risks.
Supplemental health insurance is a plan beyond your primary plan that covers costs that main plan does not. Some plans even cover costs that traditional plans do not. It can vary greatly, depending on the type of plan. Some examples of different types of these additional plans includes cancer, accident, critical illness, dental, vision and more.
Assess Your Needs
Hopefully, you are now familiar with some commonly used terms and maybe understand things a bit better. An important thing to do is to look at your past medical needs and any known issues you may be looking at in the future (like pregnancy). If you do not see the doctor very often at all, a HMO with a high deductible and high out-of-pocket max, may be a good choice for you. While you may want to look at a PPO with low deductible and out-of-pocket max, if you have a lot of health issues. Most of us will be somewhere in between and will have to weigh all the pros and cons carefully and even adding supplemental coverage.