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Which Health Care Plan Is Right for You?

A picture of a medical form.

The acronyms of health insurance alone are enough to confuse anyone. HMO? PPO? Huh? Don’t be scared away. We’ve got a simple breakdown that will help you decide which kind of health insurance policy is best for you.

There are four types of health plans – HMO, PPO, FFS and POS:

Health Maintenance Organizations (HMOs)
With this plan, you’re required to choose a primary doctor from the company's list of providers. Before you can see a specialist, you must see your primary doctor and get a referral. HMOs are the least expensive form of private health insurance, but they also give you the fewest options.

  • Advantages: Low co-payments, little paperwork, and coverage for many preventive care and health improvement programs.
     
  • Disadvantages: You must choose a primary doctor, you can only see doctors in the network, and you must get referrals to see a specialist.

Preferred Provider Organizations (PPOs)
You get discounted rates when you see a doctor in your network. If you see a doctor outside of your network, you have to make a co-payment.

  • Advantages: The co-payment is usually low. You don't need permission to see a specialist as long as they're in the network.
     
  • Disadvantages: If you see a doctor outside of your network, you may have to pay for the whole visit up front and get reimbursed. You may have to pay a deductible if you see someone outside your network.

Fee-For-Service (FFS)
FFS plans are also referred to as indemnity health plans. You pay a set amount of the cost and the insurance company pays the balance. The insurance company may pay 80% and you pay 20 percent. You can choose your own provider.

  • Advantages: You can choose your own doctors and hospitals. You don't need permission to see a specialist.
     
  • Disadvantages: You have to pay a larger part of your health care costs. You may have to pay up front for medical care and then get reimbursed, so there's more paperwork. They only cover what their plan defines as "reasonable" - if you see a doctor they think is too expensive, you have to pay the difference.

Point of Service (POS)
This insurance plan allows the insured person to choose providers or specialists with the POS plan's network, referred by their primary care physician, or to self-refer to a provider outside the network. You will receive the highest level of benefits if it uses providers inside the network.

  • Advantages: You can see a doctor outside your network. POS plans have a strong focus on preventive care and well-being services.
     
  • Disadvantages: You must have a primary doctor. If you want to see someone outside your network, you have to get permission first. Lots of paperwork is involved and you might get only a small reimbursement.

So, as you can see, which plan you choose will depend on how you want to pay for services, and how much freedom you want in choosing how you receive those services. For more help, contact a health professional or a representative from any insurance company to guide you through the process.

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if you are looking for an individual plan then ppo's are great. BCBS have some good plans

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