Types Of Health Insurance

Having access to health insurance is essential for everyone, no matter whether you need it or just want to have the peace of mind it's available. But which is the right plan? It depends on the person insured. To help with your decision, here is an overview of the main types of plans.

Fee For Service

This is the type of plan that is the most traditional. The selection of physicians and medical facilities is quite extensive, allowing you flexibility to use those that most suit your needs and situations. When it comes time to pay the bill, the insurance company usually pays a large part of it, leaving the patient to pay the smaller remainder known as the deductible or co-payment. There also are monthly payments, or premiums, paid to the plan whether you use the services or not.

There are two subcategories of coverage for these plans. They are known as basic and major medical. A basic plan will take care of the room, services and supplies used while the patient is in the hospital. It also takes care of inpatient and outpatient surgeries. But sometimes a person requires care stemming from injuries or illnesses that take longer to cure. This type of coverage is major medical. A comprehensive plan includes both major medical and basic coverage.

Health Maintenance Organization

More commonly known by the abbreviation HMO, the costs are much less than those found in fee-for-service plans. A primary care physician is paired with the patient. The doctor's emphasis is preventative care for that patient and deciding whether a medical specialist or hospitalization is essential. Such responsibilities are intended to lead to lower costs for the insurance company. For example, the insurer limits payment only to those specialists in the plan's network.

Preferred Provider Organization

Similar to an HMO, a PPO has a network of preferred physicians. While a patient actually can go outside the network if she or he chooses, there is still a network of physicians participating in the plan. Deductibles and co-payments are less for using those in the network. Those same physicians also agree to make sure their charges are reasonable to the insurance company. Patients may end up paying quite a bit more for out-of-network services because the insurer's payments still are based on what the in-network medical professionals would charge.

Point of Service

POS is a hybrid of an HMO and a PPO. The patient has a primary care physician, who is consulted before any medical treatment is done. If a specialist is needed, the original doctor can make a referral inside or outside the network. However, if the patient goes to a specialist without that referral, the insurance company might not pay for the care provided.