Frequently Asked Questions

1. Insurance

1. What is the difference between a PPO and HMO plan?
   1. HMO- Health Maintenance Plan requires you to choose a Preferred Care Physician.  This physician will in return manage your medical records and be your main point of contact.  They can also refer you to other providers if you need care that they can not provide (specialist visits, x-rays, labs).  Visiting another doctor or specialist without their referral will result in you paying a higher percentage of the cost of care.  If any of the other providers are not part of your network, you may be charged the full cost of services (what the doctor would charge a patient with no insurance at all) versus having an in network discount.
   2. Advantages of HMO plans:
      1. They do not have a deductible to meet before they cover the cost of care
      2. There is one point of contact
      3. Copays are generally lower
   3. PPO- Preferred Provider Organization will not make you select a primary care physician.  You can pick from a group of "in network providers" for the services you need.  You will not need a referral to see a specialist, but often times have a deductible to meet or a coinsurance percentage. If you do seek care "out of your network" you will most likely have to pay the total balance up front to the provider based on their own fee schedule (what the doctor would charge a patient with no insurance at all).
      1. Advantages of PPO plans:
      2. Easier to seek a second professional opinion
      3. More choices when choosing a doctor
      4. Some plans cover alternative medicine services such as chiropractic care, massage and acupuncture
2. What is a “premium”?
   1. The fixed amount you pay for your insurance. It can be monthly, quarterly, bi-annually or annually. Your employer may pay for all or a portion of your premium.
3. What does “PCP” mean?
   1. Primary Care Physician; an internal medicine physician, gynecologist (for women), family physician or pediatrician.  They will manage all your healthcare, medical records and referrals, if necessary, particularly with HMO plans.
4. What is my “deductible”?
   1. The annual amount the insurance company charges you before they pay your coverage.  Deductibles range from $100-$5000 on average. A higher deductible usually means a lower monthly premium.
5. What is the difference between “copay” and “co-insurance”?
   1. A copay is the amount you must pay each time you visit a doctor, specialist, or hospital after your deductible has been met.  If you don't have a deductible you would immediately start paying your copay.
   2. Co-insurance is based on the cost sharing arrangement made with the insurance company. Commonly, this ranges from 0-50%.
6. What is a “pre-existing condition”?
   1. An illness in which the symptoms were present prior to applying for insurance.  Often these people are denied, charged higher premiums, or receive coverage that excludes certain conditions.
7. Helpful Tips
   1. PPO plans might be a better option if you:
      1. Have a chronic condition which necessitates constant medical attention.
      2. Like to have a choice/variety of practitioners you can see.
      3. Utilize "alternative" or "complimentary" forms of medicine.
   2. HMO plans might be a better option if you:
      1. Don't have the financial ability to pay a lot of money up front
      2. Like to have one doctor/facility manage your healthcare
      3. Have been going to the same doctor, regularly for years and have no plans to see anyone else.

There are many articles available with information about insurance plans.  We are just offering a brief overview of the simplest healthcare options and terms to help assist you in your health insurance search.  If you have any questions, please don't hesitate to call. We know how difficult health insurance can be, let alone deciding which type is best for you.