Getting Started - Comparing Health Plans


 

What type of health plan is right for you?

The most common types are:

·         Preferred Provider Organization (PPO)      

·         Health Maintenance Organization (HMO)    

·         Point-of-Service Plan (POS)

·         Consumer-Directed Health Plan (CDHP)

·         Free or Low-Cost Health Insurance (CHIP, Medical Assistance)

·         Medicare

·         Long-Term Care (LTC)


PPOs offer the most freedom. They have arrangements with medical providers who have agreed to accept lower fees. As a result, you pay less for in-network providers. You may also use providers outside the network but will pay more to see out-of-network providers. No referrals or primary care practitioners (PCPs) are required.

 

HMOs are the most coordinated type of managed care. You choose a primary care doctor, and specialist services are covered only if referred by your primary care doctor. HMOs usually only cover services provided by doctors in their network. So if you go outside the HMO for care, you will probably pay the full bill.

 

POS plans are a cross between an HMO and a PPO, allowing more flexibility with providers than an HMO. With a POS plan, primary care doctors usually refer patients to other providers in the network. You can also go to providers outside the plan but you may receive limited reimbursement with higher out-of-pocket expenses.

 

CDHPs are the newest type of health plan product. They are designed to:

  • Help hold down healthcare premiums
  • Give consumers more control over how their healthcare dollars are spent
  • Feature a low-cost, high-deductible PPO plan plus a healthcare spending account

You use the spending account funds to pay for services while meeting your health plan deductible or for health-related services not covered by your plan, such as dental or alternative care. There’s normally a financial incentive for you to spend your account dollars wisely, such as allowing your account balance to carry over from year to year.

 

Free or low-cost health insurance is provided through the Children's Health Insurance Program (CHIP) or Medical Assistance (MA).  CHIP covers uninsured children and teens up to age 19 who are not eligible for Medical Assistance. Medical Assistance provides coverage for people with lower incomes, older people, people with disabilities and some families and children.  

 

Medicare is health insurance for people: 65 or older, under 65 with certain disabilities or any age with End-Stage Renal Disease (ESRD). Medicare has four parts -- Part A, which is hospital insurance, Part B, which is medical insurance, Part C, which is Medicare Advantage plans, and Part D, which is prescription drug coverage. Medicare is administered by the federal government. You may need to purchase additional insurance on top of your Medicare – this is known as Medicare Supplement or a MediGap policy. These policies can be purchased from private insurance companies in Pennsylvania.  More information is available on Medicare at www.medicare.gov.

 

Long-Term Care insurance is one option people choose to provide financial protection when they can no longer perform the most basic functions of daily activity. LTC insurance coverage in Pennsylvania provides services in your home, a medical facility or a combination of the two.

 

Return to www.pahealthoptions.com