Our agency works with a number of Health Care providers to help you stay well. From the different plan types, to selecting a care provider, to knowing what costs to expect, will all play a part in your decision. Let us provide you with a solid understanding of health insurance basics so you have the information you need to make not only a smart choice but the right choice.
HMO or PPO?
An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards.
"You're required to select a primary care physician, who will determine what treatment you need.
"You will need a primary care physician referral to be covered when you see a specialist or have a special test done.
"If you opt to see a doctor outside of an HMO network, there is no coverage, meaning you will have to pay the entire cost of medical services.
"Premiums are generally lower for HMO plans, and there is usually no deductible or a low one.
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers.
"You can see the doctor or specialist you'd like without having to see a PCP first.
"You can see a doctor or go to a hospital outside the network and you may be covered. However, your benefits will be better if you stay in the PPO network.
"Premiums tend to be higher, and it's common for there to be a deductible
Selecting a Primary Care Physician:
It's important to know how to choose a doctor that's right for you. In fact, choosing a doctor is one of the most important decisions you'll make about your health. Plus, when you use a doctor within your plan's network, you get the most out of your plan and save more money.
Do you need a primary care physician that you'll want to see for routine issues and examinations? Or, do you need a specialist that focuses on one specific area or issue? If you're looking for a specialist, make sure he or she is board-certified in the field. Board certification means that the specialist has taken a training program and passed required examinations in that field. Primary care physicians may be certified as well, but their certification is likely to be more general, such as Family Medicine or Internal Medicine.
Do you know anybody who has seen this doctor? People who select a doctor based on a referral or recommendation from a family member, friend or fellow patient are usually happy with their decision.
Once you find a doctor, its evaluation time. The best way to do this is by asking questions during your first appointment. Here are some questions you may want to ask.
"Can you tell me about your education and medical training?
"How would you describe your approach to practicing medicine?
"How experienced is your staff?
"What hospital do you use if I would need treatment there?
"Do you do tests like X-rays and lab work here, or will I have to go to a separate facility?
"Will I be able to get in touch with you directly in an emergency?
Your health insurance plan premium is an obvious cost, and most people pay it on a monthly basis. Your premium is the payment you make to your health insurance company that keeps your coverage active. Other more obvious health insurance costs include deductibles, coinsurance and copayments. Less obvious expenses may include services provided by a doctor or hospital that is not part of your plan's network, plan limits for specific kinds of care, such as a certain number of visits for physical therapy per benefit period, as well as over-the-counter drugs.
To help you find the right plan that fits your budget, look at both the obvious and less obvious expenses you might expect to pay. Here are some tips for calculating your total health insurance cost:
"Deductibles: A deductible is a way for you to share in the cost of your healthcare and, in return, you pay a lower premium. If you have different levels to choose from, pick the highest deductible amount that you can comfortably pay in a calendar year.
"Office Visits: Estimate your total number of in-network doctor's visits you'll have in a year. Based on a plan's copayment, add up your total cost.
"Prescriptions: If have prescription drug needs, add up your monthly cost that won't be covered by the plan you are looking at. Even plans with comprehensive drug coverage may have a copayment.
"Other Care: Figure in dental, vision and any other regular and necessary care for you and your family. If these expenses are high, you may want to consider a plan that covers these costs.
Established in 1936, by Thomas J. Unik Sr., our company has grown to a full service insurance agency that serves the insurance needs of over 12,000 individuals and families and 4200 business concerns in Cleveland, Cuyahoga County and adjacent areas.