When it comes to providing health insurance for your family, you want to give them the best medical insurance you can. The problem is, it can be really tough to understand the jargon that medical providers and the insurance industry use. With a little homework, though, you can understand how different family health insurance plans work and which one will be the best medical insurance for your family.
These days, most family health insurance comes in one of three basic plans: Preferred Provider Organization, Health Maintenance Organization, or Point of Service. Here’s how each of these family health insurance plans works:
In a Preferred Provider Organization, commonly known as a PPO, the insurance company offers you a network of doctors and hospitals with which it prefers to work. These health care providers have agreed with the insurance company to provide services to the plan’s members – that’s you and your family – at discounted rates. When you pay for family health insurance under this arrangement, you can choose to see any doctor or specialist within the network that you prefer, rather than being required to choose a “gatekeeper” provider known as a “primary care physician.”
People who choose to participate in this kind of system usually must pay a deductible before the insurance company starts paying for medical services. There may also be a co-payment or percentage payment of the total bill required. It really depends on the plan you select. Also, if you choose to see a doctor who is not a part of the insurance company’s network, you will have to pay a greater percentage of the cost of that doctor’s services than if you’d gone to an in-network physician.
In a Health Maintenance Organization, called an HMO, members must select a Primary Care Physician and must get a referral in order to see a specialist. Consumers receive coverage at lower costs then a PPO for giving up this flexibility. If you decide an HMO plan is the best medical insurance for your family, you will have to choose a primary care physician. This doctor will see to most of your health care. If you need to see a specialist, your primary care physician will have to refer you to one who is a part of the HMO network.
One advantage to an HMO is that this type of family health insurance provides for a broader range of preventive health care than other types of plans. This can make an HMO the best medical insurance for a growing family with youngsters who need vaccinations, dental care, vision check-ups, etc. Co-payments are usually smaller and there’s often no deductible before insurance will pay your medical costs. However, HMOs usually do not provide coverage for out-of-network services except in emergencies, and then the plans usually cover only minimal services for family health insurance.
In a Point of Service plan or POS, many of the features of PPO and HMO plans are combined. Like an HMO, you may be required to choose a primary care physician from the insurance company’s network of health care providers and you may be required to get a referral to see a specialist. POS plans are similar to PPO plans in that you are covered if you see a doctor who is not part of the insurance company’s network. Just like with a PPO however, seeking services from out of network physicians or hospitals will cost you more out of pocket because of higher deductibles and co-payments.