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Protect Yourself with Health Insurance

If you are under 65 and responsible for your own health insurance, you need a high quality and affordable plan. Even if you're a person who rarely sees the doctor, you cannot predict what your future medical expenses will be. One thing is almost certain: they will be high!

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Health plans vary widely in type, coverage, and cost. You need to understand what your options are and how to choose the best plan for your needs.

Here are some basics you should know about your health plan choices.

Fee-for-Service (Indemnity) Plans

This is the traditional health policy in which the insurance company pays the fees for services provided to the insured. You pay a premium and usually have to meet a deductible before the insurance payments begin. Thereafter you generally pay part of the medical fees, such as 20%, and the insurance company pays the rest. Your portion is called coinsurance.

There are two kinds of fee-for-service plans: basic and major medical. Basic protection pays toward the costs of a hospital room and care if you are hospitalized. Major medical insurance takes over where basic insurance leaves off, covering the cost of long, expensive illnesses or injuries.

Fee-for-service health plans allow you to choose any doctor or hospital anywhere in the country.

Health Maintenance Organizations (HMOs)

HMOs are prepaid health plans. As an HMO member, you pay a monthly premium in exchange for comprehensive care through the HMO network of service providers. Services include doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy. Your choice of providers is usually limited to those within the HMO, and your primary physician generally has to refer you to any specialists. However, your out-of-pocket expenses are likely to be lower and more predictable than with a traditional fee-for-service plan.

Preferred Provider Organizations (PPOs)

The Preferred Provider Organization is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and facilities to choose from. Most of your medical bills are covered when you use these "in network" providers. If you go outside the network, some portion of the bill is still covered, but you will have to pay a larger share. This gives you more flexibility in choosing providers than with an HMO. Also generally you can self-refer to specialists rather than having to go through your primary physician.

Point-of-Service (POS) Plan

Some HMOs give their members the choice to "opt out" and self-direct their own care as well as rely on primary care physician referrals. As a member, you can choose to go through your primary physician, in which case coverage follows the HMO guidelines. You can also visit a PPO provider and be covered under in-network PPO rules. If you decide to use a service provider outside of both the HMO and PPO, the service will be reimbursed according to out-of-network rules. POS plans vary in the coverage options offered, and under a POS you are responsible for managing your care access. Therefore it is very important that you thoroughly understand your plan and the financial implications of your care decisions.

We offer a variety of quality health plans that comply with the recent change in health care laws (ObamaCare). Contact us to find the best coverage at the lowest cost for your needs and budget.

Find HENRI CROSS on the Oregon Insurance Division website for Expert Help.