Health insurance ppo pos hmo insurance plans

If you are one of the many individuals in Atlanta who are not covered by group health insurance through your employer or other organization, you will need to go out into the market and research individual health insurance plans. Individual health insurance plans essentially come in two “flavors”: Indemnity (fee-for-service) and managed care plans (HMO, PPO, POS). In general terms, the major differences lie in the choice of healthcare providers, out-of-pocket expenses, and how the bills are paid.

Even though the health insurance market has seen a dramatic shift away from indemnity plans (due to higher costs), these plans are still often referred to as the more traditional form of health insurance since they have been around the longest.

For indemnity health plans, individuals typically pay a predetermined percentage of medical care costs (called co-insurance) and the insurance company pays the balance. A common indemnity plan is an 80/20 plan, where the insurance company pays 80% and you, the insured, pay 20%. Your insurance company will only make payment in accordance with the “usual, customary, and reasonable” (UCR) fees as determined, which are based on what health care providers charge in your area for a given service. Of course, if your individual health insurance plan has a deductible, this must be met first before this pay structure kicks in.

Depending on your indemnity health plan, you may be required to pay for services upfront and submit claims for reimbursement directly from the insurance company, as opposed to your provider directly billing your insurance company for services.

While an indemnity individual health plan allows you much freedom in terms of provider and medical facility choice, this freedom does not come cheap. The cost can vary as to how much of a deductible you have and your out-of-pocket limit. As you might expect, as your out-of-pocket expenses increase (deductibles, co-pays, co-insurance), the cost of your health care premiums go down. Even so, this is one of the more expensive types of individual health insurance plans out there.

Additional individual health insurance plans are managed health care plans, like HMOs (Health Maintenance Organizations), PPO plans (Preferred Provider Organizations), and POS (Point of Service) plans.

HMO Health Insurance Plans

Managed health care plans have become the most popular form of health care insurance coverage offered in the United States today. One of the reasons that managed care plans have become so popular is because of cost. Indeed, as health care costs continue to rise at double digit increases year after year, those looking for the most affordable individual health plans available more often than not choose managed care plans, as they are the least expensive.

Managed health care plans are plans work off the basic premise that health care costs can be better controlled by controlling access to health treatments and services. While this may be true and works to keep costs down, from a patient’s perspective, it can be difficult to get approval for health care that goes beyond basic preventative care. You will need to see doctors within the HMO network and any specialists that you do see will need to be by referral. This loss of freedom is the trade off you must accept in return for more affordable individual health insurance plans in Atlanta and elsewhere.

A Health Maintenance Organization (HMO) plan is less expensive than a PPO and generally includes coverage for preventative care. Participants are required to pay a monthly premium, and a nominal co-payment each time they see a doctor. They must be seen by medical care providers that are part of the HMO network. These medical care providers have an agreement with the insurance company to perform various medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.

The disadvantage of an HMO to an Atlanta health insurance shopper is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their ‘preferred’ doctor is not on the list. The HMO typically won’t cover the costs of medical care provided by professionals outside the HMO network. And because an HMO network is limited in size, it often takes a long time to get an appointment with the PCP.

PPO Insurance Plans

Compare free quotes for ppo health insurance online! A Preferred Provider Organizations (PPO) is similar to a HMO, except that there is no need to first be seen by a PCP. Participants are advised to choose a medical professional from the PPO’s approved ‘network’ but they don’t have to and they don’t need a referral to see a specialist. Should a participant choose to go outside the network, their co-payment will generally be higher, the percentage that the PPO pays for the medical care will be lower, and they will likely have to satisfy a deductible. PPO plans have become the most popular individual health insurance plan in the U.S. today. Well recognized individual ppo plans include the 500 750 1000 and 1500 plans from Blue Cross Blue Shield.

Although PPOs offer more freedom of choice, there are generally more costs involved in this type of managed care plan. These costs can be significant when participants go outside the network.

POS Individual Insurance Plans

A POS or Point of Service managed care plan can be described as a cross between a HMO and PPO. It offers more freedom of choice like a PPO, and a lower cost like an HMO. Participants must designate a primary care physician, but even then it is difficult to get a referral to a specialist. When participants stay within the network, paperwork is minimal, and so are co-pays. Plus, there are no deductibles. Although they might sound like the best of both worlds, POS individual health insurance plans aren’t very popular.

When considering a managed care plan, be sure to look closely at the list of in-network doctors. If you don’t see your doctor listed, you may want to forego this option. Of course, if your health care is primarily yearly check-ups and the occasional antibiotics, and you do not have a physician preference, then this is an individual health insurance plan that could work for you. It will cover health emergencies, as well; there are just more hoops you have to jump through.

The many different types of available individual health insurance plans in Atlanta, as well as individual health insurance coverage, give you many options from which to choose when selecting coverage. Be sure to do your homework; becoming an educated consumer will help you decide on the best individual health insurance plan for you and your family