by W. Michael Hurley
Finding the right health insurance coverage in today’s market can seem overwhelming. In general the more freedom you have to choose your doctor and hospital the more the cost, and the less freedom to choose your providers the lower the premium. Here is a brief run down of the options commonly seen for buyers today…
1. Preferred Provider Organizations or PPO’s – A very popular choice in the market as these types of health plans have the advantages of being able to seek treatment outside of the network, but at an added cost. These plans also encourage in network treatment when possible and provide financial incentives such as lower copays and out of pocket expense. These plans tend to have higher monthly premiums as they offer freedom to choose in or out of network treatments.
2. Health Maintenance Organizations or HMO’s – HMO’s are unique as they not only provide payment for medical treatment but often deliver the medical treatment to their subscribers. Some large HMO’s have fully staffed clinics which offer initial treatment by your primary care physician, diagnostic tests, and specialist visits. HMO’s have lower monthly premiums than a PPO plan due to the fact that subscribers can not receive treatment outside of the network.
3. Affordable Care Act or ACA Plans – Generally, ACA plans are individual health plans available to the self-employed, or individuals whose employer does not offer health insurance. Individual health plans tend to be the most expensive on the market. In Texas, plans are chosen through the federal health exchange and most individuals will qualify for some federal subsidy to help fund your monthly premiums.
4. Fixed Benefit – Fixed Benefits plans (like PPO’s) offer the freedom to choose your provider both in and out of network. They also are the least expensive health plans on the market, generally costing 30% to 50% less than major medical plans. However, fixed benefit plans are not flexible in the benefits paid. A flat benefit is paid to your provider regardless of the charge. For example if a fixed benefit plan pays $125 for a doctor visit/consultation, and your doctor’s office charge is $100 your plans pays the doctor $100 and then sends the policy holder the remaining $25. Policyholders on fixed benefit plans can profit if they shop before seeking treatment. A great alternative to the high premiums of major medical insurance.
One Size Does Not Fit All – There is no “one-size-fits-all” when it comes to health coverage, each person’s health history, risk tolerance, and budget have to be taken into consideration when selecting a plan. People who have pre-existing chronic conditions and expect to file claims during the upcoming year will probably be served well by a HMO or PPO plan that offers comprehensive benefits. Those who have a very healthy lifestyle and are not regularly seeking medical attention might be better served by a Fixed Benefit Plan. Hurley Benefit Services offers personal assistance in comparing the various health options available to you. Our agency has helped hundreds find the right coverage, and has numerous 5 star reviews on google. Let us help you become the next satisfied customer. Find out more at www.HurleyBenefits.com