Insurance?! Jesus, Shepherd of Judea which one should I choose?

Tuesday, June 15, 2010
With the new laws taking effect regarding health care this can be very confusing to say the least. It will soon come to pass that if you do not have health insurance coverage, either by choice or your employer doesn't offer it, you will have to start paying the government for it.

With all the options out there you will have to choose from.

HMO, PPO, Open Access, Coinsurance, Deductibles....arrgghhhh! It can be very confusing.

Deductibles: These are paid EVERY year by the patient and vary on individual and family coverage. The higher the deductible usually the lower the premium. Kinda like care insurance.

Coinsurance: Most in network (in network means your doctor participates with that insurance company) coinsurances are 80/20. Meaning the insurance company pays 80% of the allowable amount and you are responsible for 20% of the allowable amount. Some are 90/10 and some are even 100%.

Copays: These is a fee you pay most times for only seeing the physician. This does not include the procedures which are usually thrown in under your deductible.

Now lets look at the options on the types of coverage.

HMO - (Health Maintenance Organization) This is usually your lowest paying premium that you can get.
If you choose this type of insurance my best advice would be make certain that your favorite Primary Care Physician takes that insurance and is a HMO provider for that insurance BEFORE you sign up for it.  Because if they are not you will have to say good bye to your Primary Care Physician.  Having this type of plan you will be seeing your Primary Care Physician for EVERYTHING. They become what is known as the GATEKEEPER. And no it you are not the KEYMASTER, this is not Ghostbusters.
If you have an ear ache you have to see your Primary Care Physician instead of going to your Ear, Nose and Throat specialist.  If you are having a sharp pain in your toe due to a possible fracture because your sweetie dropped a industrial size can of peas on your foot at Costco you are going to the Primary Care Physician instead of the Orthopaedic specialist. If at that time your Primary Care Physician decides that he/she can't help you and you do need to see a specialist for something he/she will write you a referral to see a specialist. No referral?! No specialist. You are at the mercy of the Primary Care Physician.
And if you do not hurry up and chose a Primary Care Physician they will chose one for you.

Open Access HMO - Open access simply is a higher up version of HMO. You don't necessarily need a referral to see a specialist. However if you do see a specialist under this plan WITHOUT a referral you will be paying A LOT more $$$$$ to do so.  With the referral for the Primary Care Physician you will only pay for a copay.

PPO - (Preferred Provider Organization) This is the creme de la creme of insurances. Also the most expensive premiums.
This gives you access to any provider at any time without a referral.

Most of all I cannot stress to you the importance of KNOWING your policy! If you have questions...ask!

And if you have any personal questions please contact me at witchwayz@gmail.com, on twitter at witchwayz or on facebook.  Or just leave a comment.

1 comments:

Mark said...

I've had PPO for at least 10 years with Blue Shield of California. Last year the co-pay for a doctor increased to $35 a visit vs $15 previously. The premium went up a small amount but the drug coverage also sky rocketed. Drug coverage went from 10, 15, 25 to 15, 25, 40. If you have someone in your household who takes a medication that has no generic, and of course the formulary drugs are entirely arbitrary, you can easily end up with a $300 a month drug bill. It seems like the insurance companies are trying to put so much of the cost on the consumer that its hoping we don't go to the doctor and if we do, begging the doctor for a generic drug instead of what might work better in the first place.

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