Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.
Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), for example
What happens if you or your family member leaves the job? You will lose your employer-supported group coverage. It may be possible to keep the same policy, but you will have to pay for it yourself. This will certainly cost you more than group coverage for the same, or less, protection.
A Federal law makes it possible for most people to continue their group health coverage for a period of time.
Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization. Many organizations offer health insurance plans to members.
If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy. You can get fee-for-service, HMO, or PPO protection.
If you get a noncancellable policy then you will receive individual insurance under that policy as long as you keep paying the monthly premium. The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out. But it doesn't protect you from losing coverage.
This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country.
With fee-for-service, the insurer only pays for part of your doctor and hospital bills. This is what you pay:
· A monthly fee, called a premium.
· A certain amount of money each year, known as the deductible, before the insurance payments begin. In a typical plan, the deductible might be $250 for each person in your family, with a family deductible of $500 when at least two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you have count toward your deductible. Only those covered by the policy do. You need to check the insurance policy to find out which ones are covered.
Health Maintenance Organizations (HMOs)
Health maintenance organizations are prepaid health plans. As an
HMO member, you pay a monthly premium. In exchange, the HMO provides
comprehensive care for you and your family, including doctors' visits,
hospital stays, emergency care, surgery, lab tests, x-rays, and
The HMO arranges for this care either directly in its own group
practice and/or through doctors and other health care professionals
under contract. Usually, your choices of doctors and hospitals are
limited to those that have agreements with the HMO to provide care.
However, exceptions are made in emergencies or when medically necessary.
There may be a small copayment for each office visit, such as $5
for a doctor's visit or $25 for hospital emergency room treatment.
Your total medical costs will likely be lower and more predictable
in an HMO than with fee-for-service insurance.
Many people like HMOs because they do not require claim forms for
office visits or hospital stays. Instead, members present a card,
like a credit card, at the doctor's office or hospital. However,
in an HMO you may have to wait longer for an appointment than you
would with a fee-for-service plan.
In almost all HMOs, you either are assigned or you choose one doctor
to serve as your primary care doctor. This doctor monitors your
health and provides most of your medical care, referring you to
specialists and other health care professionals as needed. You usually
cannot see a specialist without a referral from your primary care
doctor who is expected to manage the care you receive. This is one
way that HMOs can limit your choice.
Preferred Provider Organizations (PPOs)
The preferred provider organization is a combination of traditional
fee-for-service and an HMO. Like an HMO, there are a limited number
of doctors and hospitals to choose from. When you use those providers
(sometimes called "preferred" providers, other times called
"network" providers), most of your medical bills are covered.
When you go to doctors in the PPO, you present a card and do not
have to fill out forms. Usually there is a small copayment for each
visit. For some services, you may have to pay a deductible and coinsurance.
As with an HMO, a PPO requires that you choose a primary care doctor
to monitor your health care. Most PPOs cover preventive care. This
usually includes visits to the doctor, well-baby care, immunizations,
In a PPO, you can use doctors who are not part of the plan and still
receive some coverage. At these times, you will pay a larger portion
of the bill yourself (and also fill out the claims forms). Some
people like this option because even if their doctor is not a part
of the network, it means they don't have to change doctors to join