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What Are My Health Plan Choices?
Choosing between health plans is not as easy as it once was. Although there is
no one "best" plan, there are some plans that will be better than others for you
and your family's health needs.
Plans differ, both in how much you have to pay and how easy
it is to get the services you need. Although no plan will pay for all the costs
associated with your medical care, some plans will cover more than others.
Almost all plans today have ways to reduce unnecessary use
of health care—and keep down the costs of health care, too. This may affect how
easily you get the care you want, but should not affect how easily you get the
care you need.
Plans change from year to year, so you should carefully consider each plan,
using the questions outlined in this booklet. If you get health insurance where
you work, you should start with your employee benefits office. Its staff should
be able to tell you what is covered under the plans available. You can also call
plans directly to ask questions.
Health insurance plans are usually described as either indemnity
(fee-for-service) or managed care. These types of plans differ in important ways
that are described below. With any health plan, however, there is a basic
premium, which is how much you or your employer pay, usually monthly, to buy
health insurance coverage. In addition, there are often other payments you must
make, which will vary by plan. In considering any plan, you should try to figure
out its total cost to you and your family, especially if someone in the family
has a chronic or serious health condition.
Indemnity and managed care plans differ in their basic approach. Put broadly,
the major differences concern choice of providers, out-of-pocket costs for
covered services, and how bills are paid. Usually, indemnity plans offer more
choice of doctors (including specialists, such as cardiologists and surgeons),
hospitals, and other health care providers than managed care plans. Indemnity
plans pay their share of the costs of a service only after they receive a bill.
Managed care plans have agreements with certain doctors, hospitals, and health
care providers to give a range of services to plan members at reduced cost. In
general, you will have less paperwork and lower out-of-pocket costs if you
select a managed care type plan and a broader choice of health care providers if
you select an indemnity-type plan.
Over time, the distinctions between these kinds of plans have begun to blur as
health plans compete for your business. Some indemnity plans offer managed
care-type options, and some managed care plans offer members the opportunity to
use providers who are "outside" the plan. This makes it even more important for
you to understand how your health plan works.
Besides indemnity plans, there are basically three types of managed care plans:
PPOs, HMOs, and POS plans..
» Continue to - Indemnity Plan
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