When buying individual health insurance, it is important to know what your options are.
Search and compare plans to get the best coverage for your money.
You will want to know what the differences are between HMO (health maintenance organization), PPO (preferred provider organizations), and POS (point of service).
Each has its advantages and disadvantages.
Buying Individual Health Insurance Under an HMO Plan An HMO has its own network of doctors and hospitals.
If you belong to an HMO, you must get services from within the network.
There are exceptions to this.
If there is a life-saving or life-altering treatment or service that is not available through the HMO's network, it may still be covered.
But this can take time and lots of paperwork to get approval.
If you are injured and taken to a non HMO facility for emergency care, you must notify your HMO within a certain amount of time or you may be responsible for all the fees incurred.
You choose your primary physician who manages care and refers you to approved specialists as needed.
Even though you have less flexibility in an HMO, you still have choices.
If you are unhappy with your family physician, pediatrician, or specialist, you can choose another within the network.
One of the advantages of an HMO is that you can have routine services or tests done without having to first get approval from your insurance company.
In many cases, your doctor can order a test or xray that morning and you can get it done the same day.
With a PPO, it may take several days or weeks before you get approved.
Buying Individual Health Insurance Under a PPO Plan A PPO offers much greater flexibility than an HMO.
You are given the option of choosing your doctor or facility from a preferred list.
A member then makes co-payments for services received.
If you choose from outside of the list, co-payments are usually higher.
The same goes for deductibles; they are usually lower for preferred providers.
A PPO determines the reasonable cost of a provider.
PPO's will usually cover 80% of the fees and you are responsible for the other 20%.
If you choose a non-preferred provider, their fees could be above the reasonable cost of service (determined by your PPO), which means you will be responsible for more than 20% of the cost of services.
PPO's can be more expensive but they offer much more flexibility in choosing doctors and hospitals.
Buying Individual Health Insurance Under a POS Plan POS (point of service) a type of managed health care plan that combines features of an HMO and PPO, giving you greater flexibility and autonomy over your own healthcare.
A POS is designed to give you good health benefits at lower costs.
It has a network of preferred providers for its customers.
After you choose your personal physician from the network, your physician can make referrals to other providers or services if needed.
For special cases, the referral can be inside or outside of the network.
If you visit a specialist without your physician's referral, you may be responsible for the entire bill.
If you are traveling in the United States and need to see a doctor for non-emergency purposes, your insurance company has a list of approved physicians across the U.
S.
from which you can choose.
A POS requires you to go through an approved physician, a PPO does not.
Because of this, co-payments under a PPO are usually much higher.
Before buying individual health insurance, look at the list of approved providers to determine if they will meet your need.
Determining factors will be your health or the health of your family, the cost, and the benefits provided.