What is the best health insurance solution for you? The answer to that question largely depends on your individual needs and requirements. There are four different categories of solutions: HMO, PPO, POS, and Indemnity plans. This blog post will discuss each type in detail so that you can better understand what they offer and how to choose one that's right for you.
Understand the difference between HMO, PPO, EPO, and Indemnity
HMO stands for Health Maintenance Organization. This is a type of health insurance plan that requires you to have a primary care physician who will manage all your healthcare needs, including referrals to specialists where needed. If you are a Canadian, you may want to look into the Green Shield benefits, which provide coverage that is similar to what you find with HMO. The plans often cover a list of doctors and hospitals, which you can choose from. In some cases, your choice may be limited to a specific plan or provider network that's authorized by the insurance company. You are required to pay a monthly premium for an HMO type of coverage.
PPO stands for Preferred Provider Organization. This is another form of health insurance that has a list of doctors and hospitals that you can choose from. However, unlike an HMO plan where your doctor is required to manage all your healthcare needs, PPO plans offer more flexibility in this area. In fact, with a PPO type of coverage, you may even be allowed to see other providers outside the network for a higher deductible.
You can also visit a specialist without a referral from your primary doctor, though you may have to pay more out of pocket if the provider is not part of your plan's network. Some insurance companies require that you get approval before seeing an in-network doctor or going to the emergency room for non-life-threatening issues. Like with HMO coverage, you'll need to pay a monthly premium for this type of plan.
– EPO (Exclusive Provider Organization)
This is another form of health insurance that has an in-network list of doctors and hospitals that you can choose from. However, unlike PPO plans where your doctor is allowed some flexibility when it comes to managing all your healthcare needs, an EPO plan requires that you use a doctor from the network. If you see someone outside of the network for non-life-threatening issues, such as routine physicals and lab tests, your claim may be denied by the insurance company. Like with HMO and PPO plans, you'll need to pay a monthly premium for this type of coverage.
– Indemnity Plans
This is another type of health insurance solution that's also known as fee-for-service plans. With this type of health insurance solution, you are free to choose your doctors and hospitals outside the network without prior approval from the insurance company. There are no restrictions on which providers you can see or where you can go for care.
However, you may have to pay more out of pocket if your doctor or hospital is not part of the plan's preferred provider list. Also, some services that are considered non-life-threatening issues can be denied by insurance companies with this type of coverage.
How to choose the right plan for you?
– Compare costs of each plan
One of the things that you'll need to carefully consider when choosing a health insurance plan is how much it will cost you every month. The monthly premium that you have to pay for these plans may vary depending on the provider and coverage type. You can compare premiums offered by different providers in your area, as well as service fees and deductibles through online quote calculators.
– Know what you are covered for in each plan
Another thing that you'll need to consider when choosing a health insurance plan is what exactly it covers. You must know the details of your coverage, such as what specific services are included and which ones aren't part of the package deal. For instance, if you have an HMO type of policy, make sure that all primary care services, including physicals, lab tests, and immunizations are covered. If you want to go to the emergency room for non-life-threatening issues or visit a specialist without prior approval from your primary care doctor, make sure that these services are included in your coverage plan as well.
Choosing the right health insurance plan is an important decision, so make sure you are fully informed about all your options. The right plan will depend on your needs. To learn more about the different plans, contact an insurance agent for you to acquire a free quote or refer to online quote generators.