Group Health Insurance And Other Alternatives

Group health insurance is very important. A group health insurance plan allows many individuals to join one group, which spreads the risk and helps keep costs down. If you can't join a group, then you can purchase individual health insurance policy which is typically far more expensive.

There are several different types of plans and organizations when it comes to insurance. One thing is sure – it’s always best to compare multiple quotes to find out which company will give you the most affordable health insurance.

Health Maintenance Organization (HMO)

Health maintenance organizations are prepaid health plans. As an HMO member, you pay a monthly premium. HMOs provide comprehensive care including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.

The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when medically necessary.

Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. With HMOs you may have to wait longer for an appointment than you would with a fee-for-service plan.

HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals.

Some services, such as outpatient mental health care, often are provided only on a limited basis.

HMOs do not require claim forms for office visits or hospital stays. Members present a card, like a credit card, at the doctor's office or hospital.

You either are assigned or choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed.

You pay a small co-payment for each office visit, such as $5 for a doctor's visit or $25 for hospital emergency rooms. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.

You usually can't see a specialist without a referral from your primary care doctor. This is one way that HMOs can limit your choice.

In some HMOs, doctors are salaried and they all have offices in an HMO building at one or more locations in your community as part of a prepaid group practice. In others, independent groups of doctors contract with the HMO to take care of patients. These networks are called individual practice associations (IPAs) and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating physicians. If you are thinking of switching into an IPA-type of HMO, ask your doctor if he or she participates in the plan.

Preferred Provider Organization (PPO)

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 hospitals to choose from. When you use those providers (sometimes called "preferred" providers, other times called "network" providers), most of your medical bills are covered.

When you go to doctors in the PPO, you present a card and do not have to fill out forms.

Usually there is a small co-payment for each visit. For some services, you may have to pay a deductible and coinsurance.

You choose a primary care doctor to monitor your health care.

Most PPOs cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammograms.

You can use doctors who are not part of the plan and still receive coverage. At these times, you will pay a larger portion of the bill yourself (and may also fill out the claims forms). Some people like this option because even if their doctor is not a part of the network, it means they don't have to change doctors to join a PPO.