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How does a PPO plan work?

As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged through their pricing of services to use the insurance company's network of preferred doctors and hospitals. With a PPO plan, services rendered by a physician that is out of their network are typically covered at a lower percentage than services rendered by a physician within the network. Usually, you won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

You will most likely have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for some services, or be required to cover a percentage of the total charges.

How does an HMO plan work?

HMO (Health Management Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in choices of physicians or hospitals than other health insurance plans. As a member of an HMO, you'll be required to choose a primary care physician (PCP) which you must see prior to being referred to a specialist.

With an HMO, you'll likely have coverage for a broad range of preventative healthcare services, some even offer discounts to health clubs. You may not be required to pay a deductible before coverage starts and your co-payments are usually minimal. HMO's typically offer no coverage whatsoever for services rendered by non-network providers or for services rendered without proper referral from your primary care physician (PCP).

What is the difference between in-network and out-of-network providers?

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. If you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, the insurance company will either pay less or not pay anything for services you receive from out-of-network.

How does the Indemnity plan work?

A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

Under an Indemnity plan, you may see the doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.

However, this kind of freedom may be costly. You'll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the "usual, customary and reasonable (UCR) rate" for the service. The UCR rate is the amount that healthcare providers in your area typically charge for a given service.

An Indemnity plan may also require that payment up front for services, and then you would submit a claim for reimbursement.

How does an HSA work?

HSAs and HSA-eligible health insurance plans are a great way for people to control their health care dollars. Here are the basics:

• An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.
• Choosing an HSA-eligible plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible plan.
• Contributions to an HSA may be made pre-tax, up to certain annual limits.
• Funds in the HSA may be invested at your discretion at a qualified financial institution of your choice. Unused funds remain in the account and accrue interest year-to-year, tax-free.
• Not all high-deductible plans are eligible for use in conjunction with an HSA.

What is a co-payment?

A "co-payment" or "co-pay" is a charge that you pay for a specific medical service or supply. You can think of this as the "office visit fee". If your plan requires a $15 co-payment that's the amount you pay for an office visit, and the insurance company pays the remainder of the charges.

What is a deductible?

A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Most Indemnity and PPO plans require you to meet the annual deductible prior to making payments.

What is coinsurance?

Coinsurance is the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, If there is a 20% coinsurance requirement, then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80 until you meet the total annual out of pocket requirement.

Finding the right health insurance plan can be overwhelming. Each state has different rules and providers. Different providers may have very different health insurance qualifications and health insurance premiums vary depending on deductible, age and health of the applicant, and the carrier. Try to find an online health insurance quote provider for your health insurance in your state. These services are usually free and can also offer the backup of experienced health insurance advisors to help you make sense of the options for you as an individual or for family health insurance.

Lorne Zalesin joined MyInsuranceExpert.com following a successful career in residential building and real estate sales. A self-proclaimed "serial entrepreneur", Zalesin is a licensed residential builder, licensed residential real estate broker, and licensed in life insurance and health insurance. Zalesin earned a Bachelor of Arts and a Master's in Business Administration, from The University of Michigan, and is also a graduate of the William Davidson Business Institute and Massachusetts Institute of Technology's (MIT) "Birthing of Giants," an elite educational program focused on successful leadership practices and unique growth strategies for entrepreneurs.

Talk with an Experienced Health Insurance Advisor at MyInsuranceExpert.com. Affordable health insurance options are out there for you and your family.