How health care system works


Health Insurance 101 Explained

We all understand the importance ofdeductible costs for hospital stays as
health insurance; however, as the typeswell as a possible larger selection of
of health insurance continue to increasephysicians that might be available with
it is becoming more and more difficulta HMO. Out of network services may also
to select the type of coverage that isbe covered; however, for a higher charge
best for you and your family. To helpthan in network services.
you find out which type of policy mightA POS, or Point of Service, is also
benefit you the most, let's take a looksimilar to a HMO in that you select a
at the most common types of policies.primary care physician. The difference
There is usually a lot of hype regardingis that you are free to choose out of
HMOs so let's look at that one first. Anetwork treatment if you're willing to
HMO is a health maintenance organizationpay a higher out of pocket cost. Â
plan that works with a specified groupAnother option is what is known as a
of doctors and hospitals within thetraditional coverage policy. This type
network. A primary healthcare physicianof policy will have a higher monthly
is selected and you must obtainpremium as well as deductibles. In
referrals for care that cannot beaddition, you will generally be required
provided by that physician. The benefitsto pay for services out of your own
of this type of plan are lower officepocket up front and then submit claim
visit costs and prescription drugreimbursement forms.
co-pays. In addition, there willYou may also wish to consider various
typically be either no or limitedtypes of disability plans, which cover a
deductible costs for hospital stays.percentage of your income in the event
Depending on your coverage, there maythat you experience an illness or
also be no pre-existing condition causeaccident that prevents you from working
limitations. It is also important tofor a period of time. A short term
understand that your choice of doctorsdisability plan will provide benefits
and hospitals will be limited with a HMOfrom the first day of an accident or the
and you won't be able to have out ofeighth day of an illness up to 26 weeks.
network services covered.Generally, this type of plan will cover
A PPO or Preferred Provider Organization66% of your weekly income.
works similar to a HMO; however, theLong term disability will begin after
major difference is that you are notshort term coverage has expired and will
required to select a primary careprovide coverage for a variable term,
physician. In addition to the benefit ofdepending on the policy you select. Some
being free to choose your own physicianpolicies are limited to providing
without worrying about a referral youcoverage up to two years while others
also gain the benefit of limited or nowill cover you up to the age of 65.



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