"Health is wealth", and everybody wants to be healthy. This is the soul reason why people opt for a health insurance..
Health Insurance can be categorized into:
Fee-for-Service Plans
Health Maintenance Organizations(HMOs)
Point-of-service plans(POS)
Preferred Provider Organizations(PPOs)
FEE-FOR-SERVICE PLANS
For years, indemnity or fee-for-service coverage was the norm. Under this type of health coverage, you have complete autonomy when it comes to choosing doctors, hospitals and other health care providers. The insurance holder can choose any doctor or any hospital in any part of the country. The person can also change doctors and hospital at any time. For this type of health insurance, you pay a lower monthly fee compared to other types of insurance policy. The monthly fee which you pay the insurance company is called a premium. Therefore in the Fee-for-service plan, you pay a low premium. Each year, an amount known as deductible is paid by you before the payments begin. The bill is shared by the insurance company and you i.e., you only pay a part of the doctor or hospital bill. For example, it might be that the insurance company pays 75 percent of the bill and you pay the remaining 25 percent. To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer. Sometimes your doctor's office will do this for you. You also need to keep receipts for drugs and other medical costs. You are responsible for keeping track of your own medical expenses. Fee-for-service plans often include a ceiling for out-of-pocket expenses, after which the insurance company will pay 100 percent of any costs. Needless to say, the ceiling is usually pretty high.
However, Fee-for-service plan have some drawbacks. You do not get all the services. Some services are limited and some are not covered at all. Members must choose their doctors, hospital, pharmacy or other medical facilities in an approved list. The insurance company do not refund any claim if a person consults a doctor and any other medical facilities outside the approved list.
HEALTH MAINTENANCE ORGANIZATIONS(HMOs)
A health maintenance organization (HMO) is a type of managed healthcare system. HMOs share the goal of reducing healthcare costs by focusing on preventative care and implementing utilization management controls. The insurance holder has to pay a monthly premium. This type of insurance usually takes comprehensive care for you and your family. HMO provides doctors visit, hospital stays, emergency care, surgery, laboratory tests and other medical facilities. It has broad hospital coverage, has a vast network of pharmacies. Health Maintenance Organizations arranges for his health care either through its own network or through doctors and other health care professional under contract. You do not have to pay a coinsurance or a deductible. You only have to pay a small copayment for each office visit such as $10 for a doctor’s visit or $25 for a hospital emergency room treatment. Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the doctor's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service health insurance plan.
In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive. This is one way that HMOs can limit your choice.
POINT-OF-SERVICE PLANS
A Point of Service (POS) plan is a type of managed healthcare system that combines characteristics of the HMO and the PPO. As the name itself says point of service, requires each covered person to select a Personal Care Physician (PCP) from a network of providers. Like an HMO, you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. If your PCP refers you to a doctor who is out of the network, the plan should pick up most of the cost. But if you refer yourself out, then you'll probably have to deal with more paperwork and a smaller reimbursement. You may also have to pay a deductible if you go outside the network and and your co-payment will be a substantial percentage of the
physician's charges (usually 30-40%).
PREFERRED PROVIDED ORGANIZATIONS(PPOs)
Preferred Provider Organization is a combination of Fee-for service and Health Maintenance Organizations. Like an HMO, it is a managed healthcare system. PPOs have made arrangements for lower fees with a network of health care providers. PPOs give their policyholders a financial incentive to stay within that network. Just like HMO, Preferred Provider Organizations also have a limited number of doctors and hospital to choose from an approved list. You do not have to fill forms to claim your money. You only have to present your card and most of the medical bills are covered. Usually, there is a small co-payment for each doctor visit or hospital stay. Like in fee-for – service plan, in PPO also you have to pay deductible and coinsurance. You must choose a doctor to monitor your health care just like it was for HMO. With a PPO, you can refer yourself to a specialist without getting approval and, as long as it's an in-network provider, enjoy the same co-pay. Staying within the network means less money coming out of your pocket and less paperwork.
After having seen these four types of health insurance, it is clear that the goal of these types of insurance is to provide a health protection to all us. It can be in different forms, in different ways or they can use different approach. Fee-for-service plan is the most affordable type of health insurance however it has certain limitations. Preferred Provider Organization has got the most options. However, it is the most expensive. Now, depending upon your income, it’s up to you to decide which insurance plan to purchase.