My HMO Experience
Several years ago when I was on an HMO Plan, I had issues with my skin. Periodically, I broke out into rashes and the itching was almost unbearable. Each time I went to see my Primary Care Doctor, he prescribed various skin creams. He reassured me that I would be all right. Unfortunately, my skin rashes and the itching got progressively worse. I asked my Primary Care Doctor to please refer me to a Dermatologist. He refused. He said there’s nothing a Dermatologist can do, that I am not already doing. After the fourth visit, my Primary Care Doctor still refused to refer me to a Dermatologist. At that point, I was at the end of my rope. I even went to the Emergency Room for which the attending physician recommended that I consult a Dermatologist. It took me saying to my Primary Care Doctor that I was afraid that I was going to scratch myself to death with the extreme itching on my arms till he finally relented and referred me to a Dermatologist. It turned out that I had a skin condition (I am now fine) and he asked me why I did not come to him much sooner. I told him that he should call my Primary Care Doctor because I wanted to see a Dermatologist for the past few months. My Primary Care Doctor thought he could treat my skin condition without referring me to someone else.
It’s impossible to say exactly what the best type of health insurance is. There are many variables that go into choosing a health insurance plan that is best suited for you. There are some basic guidelines and terms to know. Selecting the best health insurance policy can help you save money and provide the best health care possible.
An HMO, or Health Maintenance Organization, is a plan that provides patients coverage within a network of doctors. In an HMO, a client typically chooses a primary care physician (PCP) to be the regular doctor and issue referrals to specialists (also often members of the HMO) if necessary. This keeps costs down, but delays you in getting care. If you are comfortable with some restrictions on your choice of doctors and hospitals, then this is the type of plan for you. However, if want a specific doctor who is not part of the HMO network, you will be paying the additional costs.
A PPO, or Preferred Provider Organization, is a network of physicians and specialists who have worked out a negotiated rate with your insurer. It’s good for people who want to see doctors and specialists without getting a referral from their PCP. If you want the widest selection of doctors, a PPO is your best choice. Although they grant more flexibility to the patient, they often come with higher copayments and other costs.
A POS, or Point-of-Service, is basically an HMO that lets you see an out-of-network doctor. You will still be required to go through a PCP for referrals. But if you see an out-of-network doctor, the plan covers some of the costs – just not as much of the costs as a PPO plan would provide. This type of plan is best for someone who wants a cost effective plan, but will not mind paying the additional cost of an out-of-network physician.
Another option is a Fee-for-Service plan. There are several very nice aspects of this type of plan, especially its simplicity and flexibility. Under a typical Fee-for-Service plan, you choose the doctor or hospital and a claim is submitted to your insurance company for reimbursement.
An HSA, or Health savings Account, is like a personal savings account but the money in it can only be used for health care expenses. You, not your employer or insurance company, own and control the money in your health savings account. The money you deposit is not taxed.
To open an HSA, you must be enrolled in a qualified health plan. You cannot be covered by another health insurance plan and be eligible for an HSA. Supplemental insurance, such as dental, vision, or long-term care is not a qualified health plan.
With an HSA, you can set aside money tax-free to spend on a wide range of medical expenses such as: hospital care, doctor visits, prescription drugs, and dental care. However, money from your health savings account cannot be used to pay for your health insurance premium unless you are unemployed. The money you deposit in an HSA account accumulates and can be withdrawn tax-free as long as you spend it on qualified health care costs. You can check the IRS website for a full list of qualified medical expenses.
HSAs aren’t for everyone. If you have a lot of medical expenses and/or don’t make enough money to cover 100% of your costs before you meet the deductible, this type of plan may not be for you.
PFFS
A private fee-for-service (PFFS) is a plan where you are not limited to a network, but there are no guarantees that your doctor or hospital will accept the plan.
