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Dallas Individual Health InsuranceTexas Family Health Insurance
But today, more than half of all Americans who have health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans, and one of the newest, most innovative plans in over 60 years; health savings account qualified plans (HSAs). You've probably heard these terms before. But what do they mean, and what are the differences between them? And what do these differences mean to you? Even if you don't get to choose the health plan yourself (for example, your employer may select the plan for your company), you still need to understand what kind of protection your health plan provides and what you will need to do to get the health care that you and your family need. The more you learn, the more easily you'll be able to decide what fits your personal needs and budget.
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- or - Click here for immediate Assistance from Licensed Agent Texas Health Insurance Plans. What are my options?Choosing a Texas Health Insurance Plan is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ, both in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. Almost all plans today have ways to reduce unnecessary use of health care and keep down the costs of health care, too. This may affect how easily you get the care you want, but should not affect how easily you get the care you need. Plans change from year to year, so you should carefully consider each plan and review new options annually. If you get health insurance where you work, you should start with your employee benefits office. Its staff should be able to tell you what is covered under the plans available. You can also call plans directly to ask questions. Health insurance plans are usually described as either indemnity (fee-for-service) or managed care. These types of plans differ in important ways that are described below. With any Texas Health Insurance Plan, however, there is a basic premium, which is how much you or your employer pays, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by plan. In considering any plan, you should try to figure out its total cost to you and your family, based on how your family uses their benefits. Indemnity PlansWith an indemnity plan (sometimes called fee-for-service), you can use any medical provider (such as a doctor and hospital). You or they send the bill to the insurance company, which pays part of it. Usually, you have a deductible such as $1500 to pay each year before the insurer starts paying. Once you meet the deductible, most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80 percent of the Usual and Customary costs and you pay the other 20 percent, which is known as coinsurance. If the provider charges more than the Usual and Customary rates, you will have to pay both the coinsurance and the difference. The plan will pay for charges for medical tests and prescriptions as well as from doctors and hospitals. It may not pay for some preventive care, like checkups. Managed Care OptionsPreferred Provider Organization (PPO). A PPO is a form of managed care closest to an indemnity plan. A PPO has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan. If you go to a doctor within the PPO network, you will pay a copayment (a set amount you pay for certain services - say $25 for a doctor or $10 for a prescription). Your coinsurance will be based on lower charges for PPO members. If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. In addition, you may have to pay the difference between what the provider charges and what the plan will pay. Health Savings Account Qualified Plans (HSA). HSAs are the newest, most innovative form of a managed care plan. HSAs offer members more control over their health benefits, while typically reducing premiums 25-40%. HSA plans combine a qualified high-deductible health plan with a tax-favored saving account allowing individuals to provide virtually 100% coverage for their entire medical, dental and vision needs. Most plans include preventive care options that allow additional coverage for all routine wellness visits on an annual basis. HSAs offer the flexibility to visit any doctor you so choose but most do provide a PPO network to help maximize your out-of-pocket expenses. This give you, the consumer the maximum flexibility to receive the care you need, when you need it. Point-of-Service (POS) Plan. Many HMOs offer an indemnity-type option known as a POS plan. The primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, members can refer themselves outside the plan and still get some coverage. If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have to pay coinsurance.
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- or - Click here for immediate Assistance from Licensed Agent What Plan Benefits Are OfferedMost plans provide basic medical coverage, but the details are what counts. The best plan for someone else may not be the best plan for you. For each plan you are considering, find out how it handles:
Also ask about:
Some plans offer members health education and preventive care, but services differ. Ask questions such as:
What is Most Important to Me in a Plan?In choosing a plan, you have to decide what is most important to you. All plans have trade offs. Ask yourself these questions:
How Do I Compare Health Plans?After you review what benefits are available and decide what is important to you, you can compare plans. Many things should be considered. These include services offered, choice of providers, location, and costs. The quality of care is also a factor to think about.
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Health care in America is changing rapidly. Twenty-five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance and the patient would each pay part of the bill. | Copyright © Custom Health Plans, Inc. 2008 |