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Understanding Personal Insurance Health Options

Dec 25, 2007
It pays to have a thorough understanding about the personal insurance options available for health care insurance because some require out of pocket costs before any type of health care will be provided. Heath care insurance plans such as a HMO charge every member for the contract services they arrange with physicians and primary care facilities. After the monthly premiums are paid, the person is no longer responsible for any payments for the HMO services they receive.

An HMO health insurance plan works well if people are able to use the care providers that are part of the HMO network. The Health Maintenance Organization styled insurance is accepted by hospitals, and the medical care which is provided is under a strict service agreement where a set price is negotiated for all medical services. Any type of health professional that provides care in a medical facility in this network is expected to honor the pre-arranged treatment pricing and not expect full priced payments for any of the services that the patient obtains.

The Preferred Provider Organization works a bit differently in providing health care coverage to people that are part of their plans. PPO insurers negotiate contracts for certain services through physicians and other health care professionals. The insured has the option of using the preferred providers or accessing physicians that are outside of the network. The financial benefits for using the physicians in the network are substantial because the insured is expected to pay a fee for every service they receive.

Some families prefer to use a specific physician for their specific needs. To gain the financial benefits of a managed health care plan, however, the family physician must be on the list as a primary care physician for that network. The patient has more control over which physician they choose to treat them, and when care is needed, they know that the physician has agreed to provide them with care for a specific price. The insured know in advance that they are expected to pay a fee for each service that they receive and they will know the cost before care is provided.

Most people want to know certain things before they join a particular health care network. Some require deductibles to be paid for each office visit and other health care plans require the insured to pay monthly fees to help cover the health care services that they will receive in the future. Each plan has a listing of all health care providers who are part of the network, and some people with certain health conditions want to make sure that there are enough providers in their local area to treat the condition that they have.

Some health care insurance coverage is designed to be supplemental insurance and will not have sufficient coverage to pay for the high costs generated by major illnesses. Some families need two or more health insurance policies in force at all times because of these ceilings placed on covered costs. At best, an insured should expect to pay about 20% of all health care charges, but by comparing plans with specific health needs, there are ways to save money and not worry about incurring any out of pocket costs for any medical care received.
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