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Your Choices in Medical Insurance

Aug 17, 2007
There are many options for you in medical insurance and you'll find that there is no one plan that offers everything you will need. All plans differ in what is offered, what you have to pay, and how easy the services are to access. However, the following information will help you to determine what is the best medical insurance coverage for you and your family.

First of all, you will find that medical insurance plans are either that of indemnity, which are basically fee-for-service plans or managed care, which is basically an agreement to have a certain doctor look after your needs. Both of these plans have a different approach to your medical insurance.

With medical insurance under an indemnity plan, you'll find that you will have much higher costs out of your pocket and how you pay the bill. Many of these types of medical insurance plans will not pay their share until they actually receive the bill from you. The best thing about this type of service is that you will have more options in your choice of doctors, including any specialists you may need during the course of any medical treatments you may need.

On the other hand, with managed care, you will have to pay less out of your pocket, but you are very limited in your choice of doctors. This type of medical insurance will have agreements with many different health care providers to give you service at a reduced cost. This, however, is one of the main reasons why many do not like the managed care plan of medical insurance. It does not necessarily allow one to have the doctor of their choice treating them.

As the medical insurance plans change, however, many of them become very similar. There are some types of medical insurance plans that are indemnity plans but offer managed care options, as well. Under managed care, you'll find there are generally three different types:

The Preferred Provider Organization or PPO makes an agreement with health care providers to get lower fees for providing you with their service. You will have lower costs and you and your health care providers can refer yourself to another doctor should it be necessary. However, if you go outside for a referral, you will have to meet a deductible, instead of just paying for normal co-payment and you may pay a difference between the cost and what the provider will pay.

The Health Maintenance Organization or HMO is the oldest type of the medical insurance falling into the managed care plan. They offer many benefits, including preventive care, for one monthly fee. With this medical insurance, you will have to choose a primary care physician and you can only be referred to a specialist should your primary care physician deem it necessary. Some HMOs require a co-payment, while others do not. The downside to the HMO is that you can only receive coverage for services rendered by your primary care physician or a referral by them.

POS- The Point-of-Service plan is also under the HMO and allows the individual the ability to see a specialist, as long as they are an approved provider of the coverage. Your primary care physician can make a referral outside the approved provider list and you will be covered, but if you do this yourself, you will have to pay for the services provided by paying coinsurance.

The most important thing you can do when researching medical insurance options for you and your family is to ask questions and make certain you understand the coverage before you commit yourself to such an important part of your health care.
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