Choosing The Right Medical Plan
Updated: Mar 19, 2020
The following is an article “Choosing The Right Medical Plan” by Marc Primo.
Whether you are the breadwinner shopping around for a medical plan for your family or the HR head of a large company that provides HMO coverage for thousands of employees, knowing the right package to choose is a major consideration you must make that will vary from case to case.
Coverage — Nowadays, more and more health care providers compete by undercutting each other or extending coverage to more individuals for less. In the corporate setting, this might include free coverage for a spouse, and/or a discounted premium for every dependent of the primary cardholder. Before deciding on a provider, canvass as many options as you can and check out the smaller ones too. They are the ones who often give the major players a run for their money with their lower price points as a result of lower operating expenses.
Indemnity — Most healthcare providers only recognize accredited hospitals, clinics, and doctors who have previously agreed to partner with them. This presents limitations for the patient, especially if his preferred general practitioner isn’t included in the HMO’s list. The solution to this is known as an indemnity, wherein the patient’s medical insurance will shoulder a portion of the expenses of any doctor or hospital, while the member agrees to pay the balance amount.
Preferred Provider Organizations (PPO) — At the expense of the patient who will have to shoulder the bulk of the medical expenses, the PPO option however provides the most flexibility by allowing its members to venture outside the network of the primary healthcare provider and consult others when they feel that it is absolutely necessary. The trade-off with this option is that the member’s insurance company’s contribution will be minimal, seeing that the scope of service being provided is no longer part of the original plan. So while PPO offers more flexibility than an HMO, the downside to this is that out of pocket costs become more difficult to predict.
Reach — This might sound obvious, but sometimes going for the medical insurance provider with the widest reach not just in the US but around the world is the safest option to take. You may think you have nailed the perfect medical plan for your growing family at a steal, but if your chosen healthcare provider is not widely recognized, especially when you travel, then you would have just wasted good money or, worse, end up spending even more unnecessarily for medical assistance when you should already be covered.