But lately, Myron’s health issues, ranging from high blood pressure to weakened kidneys, have slowed them down. He and his longtime boyfriend, Joseph, keep separate homes and love to travel. Myron is a 60-year-old book editor in New York City. People who are managing a health condition but on a tight budget may find an HDHP saves them money in the long run. Even if you haven’t met your deductible.Īn HDHP can be an HMO, POS, PPO or EPO. And depending on your age, the plan may cover services such as mammograms, colonoscopies, annual well visits and vaccines at no extra charge. You can also deposit pre-tax dollars in your account to cover medical expenses, saving you about 30 percent. Employers often pair an HDHP with a Health Savings Account (HSA) to help you cover some or all of your deductible. HDHP with HSA: Offset out-of-pocket costs with a health savings accountĪ High Deductible Health Plan (HDHP) has low premiums but higher upfront out-of-pocket costs. In the State of Washington, PCP refers to primary care provider. In Texas, a PCP is known as primary care physician. She’ll get the care she needs at a price she can afford. Her main doctor will be her PCP, who’ll give her referrals to in-network specialists like her allergist. Her regular doctor and allergist are part of the HMO’s network. Gayle doesn’t have any serious health problems ― just seasonal allergies. And it’ll help her keep expenses down and pay off her debt faster. When it’s time to enroll in an employer health plan, she signs up for an HMO. Gayle, 30, is single and lives at home with her parents in Raleigh, NC while she pays off her college loans. Because all your health services go through your PCP, it’s important to find one you trust. Your PCP will need to give you a referral before you can see a specialist, like a dermatologist. This is the person you’ll see for regular checkups. When you sign up for a plan, you’ll choose a primary care physician (PCP). HMOs require you to use doctors in the HMO network. It’s a good choice if you’re on a tight budget and don’t have many health issues. It also often has fixed copays for doctor visits. While it may have coinsurance, it generally has lower premiums and deductibles. HMO: A budget-friendly planĪ Health Maintenance Organization (HMO) plan is one of the most affordable types of health insurance. Note: All people listed in the guide below are fictional and used as examples. You have more freedom to choose which doctors to see, but out of network care will cost more. With a PPO, or preferred provider organization plan, you don't need a referral to seek additional care. However, you can visit doctors out of network but it will cost more. With a POS, or point-of-service plan, you also have one PCP who manages your access to other doctors. With an HMO, or health maintenance organization plan, you pick one PCP under your plan's network who provides routine care and refers you to in network specialists for additional care. Some plans require a primary care physician, or PCP, as a gatekeeper to direct you to in network care. The fence around the garden separates in network from out of network. It's made up of doctors and hospitals that have agreed to lower their rates while meeting quality standards. What's the difference between an HMO, a POS, and a PPO health plan?
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