by Guest » Fri Apr 27, 2012 07:26 am
I am a 34 year old single mother and live with my boy who is now 13. I am considering to buy health insurance for both of us. I've heard about HMO, PPO and POS. But am confused that which of them is going to work for us. Moreover, what is the basic coverage limit that i need to get for us? Obviously, I want affordable premiums.
Posted: Sat Apr 28, 2012 11:30 pm Post Subject:
There is virtually no more discussion (for the time being) concerning "coverage limits" in health insurance. Obamacare is mandating that insurance companies provide unlimited annual and lifetime medical expenses.
Based on your particular needs, the questions you should ask concern what is and what is not covered, and whether coverage is 100% or less. You also need to ask about copayments ($$) and coinsurance (%%) that apply to the services you receive.
Recent articles indicate that insurers will seek to overcome the negative aspects of Obamacare's mandates through higher premiums, copays, and coinsurance.
HMOs and POSs are similar. You receive your care exclusively within the provider "Network" and the HMO generally requires that you obtain all referrals to specialists through your Primary Care Provider (PCP). A POS usually permits you to seek specialist care within the network without prior referrals. Emergency care is ALWAYS covered, in or out of the network, but outside the network some of the costs may not be covered to as great an extent as they are in the network. Obamacare will eventually require ER copays in HMOs and PPOs to be the same in or out of network.
If your current In-Network ER copay is $50 and your out-of-network copay is $100, if and when the law kicks in, what do you think will happen to the ER copay? Drop to $50 or increase to $100?
There are no more distinctions between premiums for men and women in the individual health insurance market. This is the reason that there is so much discord over things like "free" birth control pills/devices for women. NOTHING IS FREE. Men (and women who cannot bear children) will be forced to subsidize this for women.
PPOs are an evolution from HMOs. You may receive covered services from any licensed healthcare provider -- inside the Network or outside of it. Your share of the cost will be higher outside the network where fees are not controlled by contracts between the provider and the insurer. Used most effectively, PPOs provide the highest level of benefits at the lowest cost when you stay within the network of approved providers.
Add your comment