Deciphering Health Care Insurance Plans

by Michele Postler, Saturday, December 8, 2012

The new US health care reform will be in full swing by 2014, this will require all Americans to have health care insurance or pay a fine if they don’t. Some have either full or partial coverage through work but even if you have partial coverage through work you will be required to fund the remainder from your own pocket. The US will be introducing exchanges where you will be able to easily compare health insurance quotes as well as buy the insurance. One problem with this is that health care insurance is complicated and there are so many different facets that need to be considered before buying.


The biggest question facing someone without health insurance currently is how much is health insurance. Hopefully, the below will provide a better understanding of the different types of health insurance options that are available to you and will make that decision easier when the time comes to actually purchase the insurance.


  • Preferred Provider Organization is a type of plan that is based solely on the health care provider that you choose. You will have to choose a doctor and hospital that is part of this plan to get the highest coverage offered. If you choose to not use a doctor in the preferred provider organization you will have to pay something that is called a copayment, which means you will have to pay the difference of what your plan offers, out of pocket. Deductibles are also evident in this plan, as some plans will only reimburse your costs after you have paid a certain amount first.
  • Health Maintenance Organizations are a type of plan that bases their coverage on preventative care. The physicians in the health maintenance organization will provide most of your general care and refer you to a specialist within the organization if necessary. The physicians under this plan are salaried and therefore are provided a fixed fee for your care. It is in their best interest to provide preventative coverage before a condition worsens. There may be a small copayment fee that will require you to pay a small amount out of pocket for every visit. Generally this plan is the least expensive of the health care plans.
  • Health Savings Accounts are available for people who currently have a high deductible plan and do not visit doctors on a regular basis. These savings accounts are to help someone who does not need coverage much at the moment but would like to save money for future visits due to an emergency. This account can also be used to fund medical needs that are not covered by their current plan. If the money is not used, it is invested and the growth is tax free as long it is used for medical expenses in the future.
  • Point of Service plans allow the member to refer to specialists outside the plan. If there is a specialist that is not part of the point of service network the insurance will cover this visit almost fully. That is only if your doctor initiates the referral. If you initiate the referral you will have to pay coinsurance which means the insurance will only pay for a certain percentage of the costs, you will have to pay the remainder out of pocket.
  • Indemnity plans provide the most freedom with regards to the doctor and hospital you choose. They do not have a set list of physicians or institutions that you have to visit to get the coverage you want. Since they do allow this freedom the plans are more expensive. There is also a lifetime limit that the insurance will cover so it is important to read the fine print and make sure that limit is realistic for your needs.

Now that you know the basics you can coordinate these plans with the coverage options you or your family will require. There are many resources including instant health insurance quotes online that can provide you with some idea of the costs associated with each plan.