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Medical Insurance

There are many different types of medical insurance plans available. Selection of coverage is likely based on how much control you would like to maintain over provider choices -- in light of how much you can afford to pay. Information on common types are provided here.

Traditional Indemnity
Preferred Provider Organization (PPO)
Health Mantenance Organization (HMO)
Point of Service (POS)
Medicare/Medicaid/Medigap

Traditional Indemnity

Each year you pay 100% of covered types of expenses up to a certain dollar amount limit, this is called the deductible. After you've spent this amount you split additional costs with the insurance company (called co-insurance), again up to a certain maximum amount, called the stop-loss. After you've paid the maximum deductible and co-insurance amount the insurer pays 100% of covered expenses for the rest of the year. For instance: each year you pay the first $500 in expenses (deductible) and then you pay 20% (co-insurance) of the next $5,000 (stop-loss) of expenses for a total out of pocket maximum for covered expense of $1,500. Any covered expense during the remainder of the year in excess of $5,500 is paid 100% by the insurer. You can use any health care provider.

This plan is good for people who travel a lot and/or are willing to pay a higher premium than other forms of medical insurance for the ability to use any provider they want.


Preferred Provider Organization (PPO)

Like a traditional plan you have a yearly deductible and coinsurance maximum you might have to pay. However, the coinsurance amount you pay will vary by whether you use providers in a designated network (preferred providers) or not. You pay a higher coinsurance amount when after meeting the deductible you use non-network providers. When you use a network provider you pay a lower coinsurance and pay a fixed dollar amount (co-pay) for the cost of the office visit instead of the full charge. Everything else works the same as a traditional plan.

Good for people who want to retain choice of provider, can afford to pay more if they use non-network providers and want to pay a lower premium than a traditional plan.


Health Maintenance Organizations (HMO)

You pay a fixed dollar amount (co-pay) for each type of service you get and the insurer pays the balance of the costs. Usually there is a maximum amount in co-pays you pay each year. You must use providers in a specific network. If you do not you pay all of the costs for care. The usual non-network coverage is only for emergency (life-threatening) care or urgent (not life threatening but needs immediate attention, i.e.: a cut that requires stitches to stop bleeding) care. Also, you usually must choose a primary care physician (PCP) who you must see first for any care. If the PCP can't give you the proper care the PCP must give you a referral to another provider in order for the plan to pay for your care.

This plan is good for people who don't travel a lot and want to pay a lower premium in exchange for working with a high level of managed care.


Point of Service (POS)

Typically there are three levels of coverage. The first works like an HMO with you having a PCP and getting referrals to other network providers. You have an office co-pay, never a deductible and low coinsurance amounts. The second level is where you self-refer within the provider network. Here you'll have to pay a deductible and low level of coinsurance. The third level involves using non-network providers and has a deductible and higher level of coinsurance, along with certain types of care not covered, such as, preventative check-ups.

Note: Premiums are slightly higher than an HMO but, lower than a PPO.


Medicaid/Medicare/Medicare Supplements (Medigap)

See section on Government Programs.

 

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Irish Martin-Danhoff
FirstLight Home Care
1019 39th Avenue
Greeley, CO 80634
970-515-5025

Expertise:
Home Care Services : Non-Medical

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