INDIVIDUAL OR GROUP HEALTH

Types of Health Insurance Plans

The bottom line:

• HMO plans generally have lower up-front costs, or premiums, than other types of plans.
• They usually feature low deductibles or no deductible at all. A deductible is the amount you pay out-of-pocket before your plan kicks in.
• HMOs usually feature low copayments as well. Copayments are set amounts (usually a dollar amount or a percentage) that you pay for care. An example of a copayment is $20 for each office visit.
• HMO plans generally provide the highest level of coverage - meaning the lowest cost for you - when you use doctors, hospitals and specialists that are in the network.
• If you seek care outside the network, your care may not be covered at all.

PPOs

Like HMOs, PPOs often feature a network of doctors, specialists and hospitals; however, there are some key differences between the two types of plans.

PPO basics:

• With a PPO plan, you don't have to choose a primary care physician.
• You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

Key features:

• PPO plan premiums are generally higher than HMO plans, which means you'll have to pay more up front.
• When you receive care from a doctor or hospital that is in the network, your costs tend to be lower.
• When you receive care from a doctor or hospital outside the network your costs are likely to be higher, and, in some cases, your care may not be covered at all.
• PPO plans usually have a deductible. So, for example, if your PPO plan has a $500 deductible, your coverage doesn't begin until you've paid out-of-pocket for the first $500 of your own medical expenses. Preventive care services are not subject to the deductible.

CDHPs and the HSA Option

Consumer Directed Health Plans (CDHPs) often involve pairing a high deductible PPO plan with a tax-advantaged account, such as a Health Savings Account (HSA). For an individual to establish an HSA and contribute money to the account each year, he or she must be considered an HSA-eligible individual. Eligibility includes enrollment in an HSA-qualified high deductible health plan.

Key features:

• If the plan uses a PPO network, you don't have to choose a primary care physician.
• You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

The bottom line:

• When a CDHP includes a high deductible health plan, premiums are often lower than other types of health plans because you are responsible for a greater share of your health care costs.
• If the health plan is an HSA-qualified high deductible health plan, and you are an HSA-eligible individual, you may establish an HSA and make contributions to the account each year.
• An HSA is a savings account that you can use to cover a wide range of qualified medical expenses. HSAs have special tax advantages and are regulated by the Treasury Department.
  
   

Medicare Supplement Insurance

Medicare Supplement Insurance (“Medigap”)

Medicare Supplement insurance is a private health insurance plan that helps pay deductibles and coinsurance that Medicare does not pay. Often referred to as “Medigap insurance,” it is different from a Medicare Advantage plan because you remain in original Medicare (Medicare Parts A and B).

Medicare Supplement Key Features

• Medicare Supplement or Medigap plans are sold by private insurance companies.
• The policies are standardized, which means that they are all the same, and are identified by letters (Plans A through N). The benefits of each insurance company’s Medicare Supplement plans must be the same so you can easily compare price.
• Each plan covers one person, so you and your spouse must each purchase your own plan.
• You must also continue to pay the standard Medicare Part B premiums in addition to your Medicare Supplement plan premium.
• The plans are automatically renewed each year as long as you pay your premium and follow policy rules.
• Not all types of Medicare Supplement or Medigap policies may be available in your state. Not all companies sell each plan; they are only required to offer Plan A.
• If you need more information about policies offered where you live, contact your state insurance department or state health insurance program (SHIP).

     Short Term Medical  & Dental Plans