When a serious illness strikes, the knowledge that a comprehensive health insurance plan is in place is reassuring and comforting. But very often, the intricate details of coverage only begin to be understood when critical care is needed.
Between eighty and eighty-five percent of Americans are covered by some kind of insurance, most often provided by an employer. While many employers choose only one insurance plan for their workers, others contract with a number of providers so that their employees are able to choose from several. Those plans which offer more choices to their members are usually more expensive and the employee is expected to pay the extra cost. People who are not covered through an employer will also find that the cost of thier individual policies will vary depending on the extent of coverage, its flexibility, and the amount of money that they are expected to put forward as co-payments at the time of service.
Those who have some choice in the type of coverage they will have should review their options carefully to be sure that they choose the insurance that fits best with the way they want to deal with their medical doctors, hospitals, and other health care services. It may be nearly impossible to change the type of coverage once treatment for a serious illness has begun, and depending upon the plan in place, there may be few treatment options.
These are the types of insurance plans which cover most Americans:
Fee-for-Service or Indemnity plans are plans in which the patient chooses his doctors, including specialists, without restrictions. Although very desirable because of the flexibility they offer, they are no longer easy to find, and may be very expensive. Some plans require the patient to pay up-front for the services they receive and to submit claims for reimbursement.
A Health Maintenance Organization (HMO) provides all health care through it's own medical providers, in exchange for one premium. There may be nominal co-payments for medicines or services, but the major limit is to a patient's choice of doctor and hospital. A primary care physician within the system coordinates all care, and in most cases must make any referral to a specialist, who is also affiliated with the organization. Any treatment received outside the HMO is not covered and must be paid for by the patient.
The Preferred Provider Organization (PPO) contracts with providers to provide health services at discount prices. As in an HMO, the patient chooses a primary care physician who is responsible for providing all of the usual preventative and curative services, and who also refers to specialists within the network when necessary. An additional element of flexibility allows the patient to seek consultation or treatment outside the system if he prefers, but at a higher cost.
A Point-of-Service HMO is an HMO which offers the usual HMO benefits using its own medical organization doctors and services, but also allows its members to see outside providers at an additional cost.
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