The ABCs of Health Insurance

The purpose of health insurance is to provide medical and financial protection. Health insurance is a fluctuating business where there are always new options for you, your family, your business and/or your employees. Tampa offers many options for those looking for individual, family, group or small business health insurance. 

Although the city of Tampa helps low income families get some healthcare coverage through government and health care services and federally qualified programs, the rest of the citizens who don’t qualify for these government-aided plans must get private insurance.

People shopping for insurance must realize that health plans do not cover everything. It is vital that you choose an insurance plan that addresses your need; this will help you save money in the long run.

Hereunder, we’ve posted in simple terms the type of health insurances plans offered in Tampa and the rest of the USA.

Health Maintenance Organizations or HMOs:

 

This is the solution to costly health plans. The HMO model involves a copayment cost share scheme, in which one would pay a general payment upon the use of a service.  
 
With an HMO, you receive a range of health benefits for a set fee. Generally, there are no deductibles – but most plans require a small copay per office visit (around $10-25). You must choose a primary care physician from the plan’s list. This doctor becomes your “gatekeeper” for all your medical needs. This is the doctor you call or see when you are sick, and he or she will refer you to a specialist or other providers within the HMO network. With most HMOs you will not receive benefits if you go out-of-network, except for emergency care.

Types of HMOs:

  • Staff Model HMO
    A form of HMO in which doctors are employees of the HMO and you see them at a central medical facility.
  • Individual Practice Associations (IPAs)
    Here, an HMO contracts with outside physician groups or individual doctors who have private practices. This means the HMO network will include doctors in various locations rather than only at a central facility.

The coverage of a PPO (Preferred Provider Organization) is considered to be the least expensive of all. Under the PPO, a discount could be obtained instead of paying the regular rate. But unlike the HMO, a copay is not involved in this program. However, it does have a deductible and a coinsurance feature.  In this system, you may seek treatment from an approved network of providers, or may see other providers outside the network. Usually, you will pay small copay and satisfy a deductible before benefits are paid. Then you’ll pay a set coinsurance amount. It’s less expensive to visit one of the providers in the plan’s list. You can go outside the plan’s list, but your share of the bill will be higher.

Point of Service (POS)
A POS is a hybrid of the HMO and PPO. Like a standard HMO, your primary care doctors make referrals to other providers within the plan. But if you want to go to a physician outside the network without consulting your primary care doctor, the POS plan will pay a predetermined amount of the bill and your share of the bill will be higher than it would if you stay in-network. These plans usually cost more in monthly premiums than straight HMOs, but they give you the flexibility to call any doctor – within the plan or not.

An HSA or a Health Savings Account, on the other hand, offers different ways for health care to be paid. It allows individuals to pay current health care expenses and at the same time save for future health expenses, tax-free. However, individuals must be covered by the High Deductible Health Plan (HDHP) to obtain HSA.

If you have a choice from more than one plan, compare how each plan handles the following:

  • Coverage
  • Co-payments
  • Coinsurance
  • Deductibles
  • Pre-existing conditions
  • Limitations on devices, drugs, and access to specialists.

Being an informed customer will help you make better choices and save money as well.

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at McKnight & McKnight Insurance Solutions is here and ready to make the process as painless as possible. We look forward to meeting you!

New Side Bar
Call Email Book Now Quotes
×

Request a quote now!

Skip to content