| Medical coverage choosing is important if you are to | | | | specialist without outside approval. You may even see |
| receive the kind of care you want at a cost you can | | | | a physician outside the network, although the level of |
| afford. Generally, there are three kinds of coverage | | | | coverage may then be reduced. |
| available for private purchase: HMO plans, PPO plans, | | | | Key disadvantages: First, policy premiums may be |
| and POS plans. Each should be examined and fully | | | | more expensive, and services may only be covered |
| understood before proceeding with medical coverage | | | | on a percentage basis. Second, ancillary services (labs, |
| choosing. | | | | x-rays, pharmacy, etc) and allied health services |
| HMO Plans | | | | (respiratory therapy, physical therapy, counseling, etc) |
| "HMO" stands for "Health Maintenance Organization" | | | | may not be covered and/or may be inconveniently |
| and refers to health care plans that are largely | | | | located. |
| self-contained. In HMO systems, all services are | | | | POS Plans |
| provided through the organization itself. | | | | POS refers to a "Point of Service" or traditional |
| This approach has many advantages. The first is | | | | fee-for-service health coverage. The greatest |
| convenience. If you need a health problem addressed, | | | | advantage of this plan is that you can select virtually |
| you typically need not search for services, programs, | | | | any physician you want, anywhere, to provide your |
| or specialists in order to receive care. A second | | | | medical care. Specialist referrals, ancillary services, and |
| benefit is cost. HMO coverage is typically among the | | | | allied health providers may also be obtained relatively |
| least expensive available, and bothersome claim forms | | | | easily. |
| are usually not required. Third, other support services | | | | However, POS plans are among the most expensive |
| (x-rays, lab tests, physical therapy, etc) are usually also | | | | available. Further, you must use detailed claim forms, |
| easy to receive. | | | | and you may even be required to pay the medical |
| Key disadvantages: First, all services must be provided | | | | provider up front, and only later be reimbursed by the |
| through the system - even some emergency services | | | | plan. Out-of-pocket expenses are also often higher, |
| may not be covered if they are provided elsewhere. | | | | and the percentage of costs covered may be much |
| Second, you may not select your own medical | | | | lower. Therefore, flexibility versus high costs are key |
| provider. Rather, one will be assigned to you. Even | | | | factors in POS medical coverage choosing. |
| then, you may still be seen by alternate providers | | | | Other Plans |
| when it is convenient to the system. Third, you may be | | | | COBRA plans are coverage options made available |
| denied specialist care, unless the system determines it | | | | when you lose employer-based health insurance. |
| is essential. Thus, cost savings versus reduced | | | | College and university students may also be offered |
| personal control are key factors in HMO medical | | | | low-cost coverage options. Low-income individuals and |
| coverage choosing. | | | | families may also be eligible for state-sponsored |
| PPO Plans | | | | coverage (Medicaid). High-risk individuals (i.e., those with |
| "PPO" stands for "Preferred Provider Organizations" | | | | pre-existing medical conditions) may need to select |
| and refers to a network of providers that have | | | | from among your state's pool of "Risk Providers". |
| contracted to offer services under a particular health | | | | Medical coverage choosing that meets your budget |
| insurance plan. The benefits include: Greater flexibility in | | | | and personal needs can protect your family from |
| selecting a physician and the clinic or office where you | | | | catastrophic health care costs. However, making a |
| will receive your care. Claim forms may not be | | | | well-informed choice can help you be pleased with the |
| required, or are greatly simplified. You may see a | | | | services you receive and the costs involved. |