There are many different types of health care plans out there, so you will need to find the one that meets your needs. Unfortunately, browsing through comprehensive health care plans can seem overwhelming when you don’t know what you’re looking at. Fortunately, learning a few key terms can help you pick out just the right insurance plan for you.
Your copayment is the amount that you owe your doctor’s office at the time of service. For instance, you may need to pay $30 to receive treatment, but your insurance will cover the rest of your bill. Plans can have different copayments for each type of service.
If the company you work for doesn’t pay for at least one-third of your insurance plan, you will likely be eligible for a Massachusetts health plan through the Connector. These are health maintenance organizations that have been deemed good value plans.
Health Maintenance Organizations
Health maintenance organizations cover preventative care, medical procedures, and hospital visits. However, you are only covered if you receive your care from one of the approved organization providers. Additionally, you will likely have to pay a copay to receive medical care. In this case, you will pay a small upfront fee, and your insurance company will cover the rest.
Preferred Provider Plans
Like health maintenance organizations, preferred provider plans cover preventative care, medical procedures, and hospital visits. The difference is that these cover the services you receive in a certain network of providers and those outside of the network. However, they will pay more of the cost if you use a provider within their network.
An example of how this plan works is that they may pay all of your fees if you go to a provider in the network and 80 percent if you visit one outside of the network. Additionally, you may receive the entire bill from a provider outside of the network and have to be reimbursed by your insurance company.
Major Medical Plans
Major medical plans cover doctors and hospital visits when you experience a sudden illness or accident. In addition, some of them can cover office visits and preventative care. However, these will generally not cover the entire cost of your visit. For instance, your insurance company may only pay 80 percent of your bills, and you have to pay the rest. The biggest benefit is that you are covered no matter which provider you visit.
A discount plan is not an alternative to health insurance. With discount plans, you pay a monthly fee to receive health care at a reduced rate. Since they don’t make payments whenever you receive a service, they are not considered insurance. Instead, they reduce the amount that you pay out-of-pocket for these services.
Aside from not covering your health services, they don’t help you meet your minimum individual health insurance requirements. Check with your doctor’s office and pharmacist to see if you will receive any real savings before purchasing a discount plan.
Whether you’ve been around the block or are looking to purchase your first insurance plan, these can be confusing. Therefore, you need to stop and learn some of the terms. Remembering the information on this page can help you get the best plan for your needs.