Reimbursement Insurance Plans

PPO plans allow you to choose any doctor or hospital that accepts PPO without a written referral. Plans allow the insured to choose a doctor or hospital from a list of “preferred” providers in order to receive maximum benefits. Be aware that you will typically have to pay a co-pay with this type of health insurance policy. This means that when you see a doctor, go to a lab, or stay in a hospital, you will pay a set amount. In addition, if you need to see a specialist, it is your responsibility to make sure your doctor sends you to other “preferred” providers.

With an HMO plan, you choose a doctor or hospital on an HMO specified plan list. With an HMO, you MUST get a referral to go to any other doctor, specialist, or hospital from your Primary Care Physician. An HMO’s coverage is definitely more limiting but costs much less than the more flexible PPOs. The drawback to an HMO is that it requires paying a “deductible.” This means you would pay a set amount, for example, $100, before the insurance company begins paying benefits. This amount can run anywhere from $100 to a few thousand, depending on your policy, health history, etc. After your deductible is paid you will pay only your portion or co-payments.

For example, most plans pay 75% to 85% of all eligible medical costs above the deductible. For example, a medical cared bill totaling $10,000 of eligible expenses would leave you paying $150 to $250 above the deductible.

Government-Sponsored Health Programs

Medicare is a federal program, which provides medical coverage for people over the age of 65, and for those who are permanently disabled. Contact your local Social Security office for more information and enrollment instructions.

These organizations offer group health insurance as well:

  • Credit Unions.
  • Professional clubs.
  • Professional Organizations.
  • Some other financial institutions.
  • Some colleges and universities.

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