Indivudual Health

Individual Health

In today's world, selecting a health insurance plan can be a challenging process. With all the choices, it's almost impossible to be sure you are selecting a health insurance plan that will satisfy your needs and budget. Our goal is to make the process a little less challenging and help you get the insurance coverage you deserve. Health care coverage comes in almost as many variations as there are people who need it. The most common system of care delivery today involves some level of Managed Care. Managed Care means that the medical decisions that affect you are based on sound medical experience and include - in some cases - review processes that are intended to protect the patient from unnecessary treatment and the insurance company paying for unnecessary and potentially harmful treatments.

The Different Types of Managed Care Plans are briefly described below:

Health Maintenance Organization (HMO)
This is the most controlled type of health care plan. You must use the HMO's doctors and facilities. Medical care outside the system is sometimes not covered. While you may lose some "freedom of choice," you benefit from lower out-of-pocket costs. HMOs typically have no deductibles or plan maximums. For each visit, you pay only a small fee ("co-payment"), or nothing at all.

An HMO can be a good choice if you don't mind the restrictions, if its facilities are convenient, and if you want to avoid most out-of-pocket expenses and paperwork.

Point-of-Service Plan (POS)
This plan type functions somewhat like an HMO, but allows you to choose a different doctor or hospital each time you need care, if you so desire. To receive the highest level of benefits, however, you must choose a doctor or hospital within the network. If you choose a provider outside the network, you will have to pay higher out-of-pocket costs. In some cases, you may still be required to select a Primary Care Provider who helps direct most or all of your care.

Preferred Provider Organization (PPO)
This is a modern version of the "traditional" insurance of days past. It is essentially a plan that contracts with a network of doctors and hospitals that have agreed to accept a discounted fee for the services they render to plan participants. When you enroll in a PPO, you can choose any doctor or hospital on the list of "preferred providers." If you select a provider who is not on the list, your out-of-pocket expenses increase. Some PPO plans offer preventive services. These services are designed to help you maintain your health by providing lifestyle recommendations and educational materials.

Unlike an HMO, with a PPO plan you will most likely need to pay a deductible and there are generally plan maximums applied. If you are looking for freedom in choosing your doctor and hospital, and are willing to pay some additional costs, a PPO may be right for you.

Your coverage with fee for service health care

Fee for service health care offers you unlimited choice. You control your choice of physician and facility, from primary caregiver to specialist, surgeon and hospital. Flexible coverage also means immediate treatment for medical emergencies or unexpected illness.

But fee for service health plans do have care restrictions. They do not traditionally cover preventative medicine, so check-ups, office visits and shots (among a few other services) are your responsibility. This can make indemnity insurance impractical for a large family that requires a lot of routine visits and preventative care.

Choice does not come cheap. While it's hard to predict the annual cost of health care under an indemnity insurance plan, there are a few costs that come pretty standard:

• a monthly health insurance policy premium.
• a yearly deductible before your health insurance begins to contribute.
• a per visit coinsurance, or percentage of health care expenses after the deductible is met

For complete details regarding benefits, rates and limitations and/or an analysis on how we may help you design your benefit program. Contact Benefits Plus at 978-683-7088 or use our contact page.