Health Care Plan

Basic Health Care Plans

Health care insurance has never before the most controversial issue for debating.  It is no doubt that we all need it but how to have it is another question.  To cope with the ongoing increasing higher medical care costs, it is very important to have yourself and your loved ones covered.  This will boil down to the question which health care plan is affordable yet suitable for you as an individual or for your family. 

In general there are four types of health care plans namely (1)- Fee – for – Service Plans; (2)- Health Maintenance Organizations (HMO); (3)- Point of Service Plans (POS); and (4)-  Preferred Provider Organizations (PPOs).

• Fee – for – service Plans: Under this plan, insurance companies pay fees for the services rendered to the insured members. This policy allows insured members to visit hospitals and doctors of their choices, either in or out of the network.  As part of the policy, members are due to pay monthly fee called premium and part of the medical service bills as agreed upon in the policy, while the insurer will pay part of it.  The insurer will not, however, start paying your health care bills until your annual deductibles are met.  Annual deductibles are out of pocket amount that paid by members on top of monthly premiums. There is also a cap amount which indicates the maximum amount that members will have to pay out of pocket on that given year.  Under fee for service plans there are basic and major medical coverage.  The former covers the costs of room and care services you receive in the hospital.  The latter covers costs of major illnesses or injuries.  Sometimes they offer comprehensive plans that cover both of these above coverage at higher monthly premium dues.
• Health Maintenance Organizations (HMOs): This is prepaid health plans, under which you and your family will be provided comprehensive care by the plan provider’s own practicing network (i.e. their own physicians, nurses and hospitals).  Members are due to pay monthly premium and some co-payment for each visit to medical care service. The general medical care costs under this plan seem lower and quite predictable than those of Fee – for – Service Plans.  HMOs basically provide preventive care such as vaccinization, immunizations, mammograms.  
• Point of Service Plans (POS):  This plan is considered a modification of HMOs, under which the plans allow both your and your primary physician usually make referrals to other providers regardless whether they are in network or out network, yet members still get coverage.  In case your physician refers you to out network provider, the plans will cover the entire bill but if you select out network provider yourself then you are required to pay coinsurance.
• Preferred Provider Organizations (PPOs): This plan is considered more advanced than others, and a combination of Fee – for – Service and Health Maintenance Organizations (HMOs).  If you use in network providers, all your medical bills are covered. Although you still have to pay small co-payment service fee for each doctor visit and deductibles as well as monthly premium.  Most PPOs offers preventive care and in fact require you to select your primary physician to monitor your health care.  If you choose out network providers, you still get partial coverage.