Do you know your PPOs from your HMOs?
Health insurance lingo can get confusing, so let’s clarify some of the basic terminology.
HMO (Health Maintenance Organization) health care plans are the cheapest. In this type of plan, you get to pick a PCP (Primary Care Physician) to take care of most of your health needs. If your health problem is too complicated for a physician, your PCP schedules a time for you to meet with a specialist. The disadvantage of using a HMO plan is that you can’t go directly to a specialist if you have a problem– you have to get a referral first.
If you don’t like the idea of seeing a physician first before meeting with a specialist, you can opt to get a PPO (Preferred Provider Organization) plan. PPO health care plans are more expensive, but offer more freedom because you can go directly to any specialist in the network.
What’s a premium?
The premium is the total cost of your health insurance plan. In other words, the premium is the amount that you’ll pay each year for your insurance. Usually, the premium is broken up into 12 monthly payments but some companies will give you a discount if you opt to pay annually or semi-annually.
What kinds of factors affect the premium?
If you are a young non-smoker and live a healthy lifestyle, your premium will probably be able to get low health insurance quotes. If you are older and have preexisting medical conditions, health insurance companies will charge you more money to even out the risk. Also if you are buying health insurance without assistance from an employer, your rate will be higher. Still, even if you are unemployed, you can still collect health insurance quotes and sign up for health care online. Just look for companies that offer individual insurance plans. Individual plans are good for self-employed people, unemployed people or workers who don’t have access to health insurance through their employer.
What’s a copayment?
A copayment is the amount you’ll have to pay every time you go to the doctor, refill your pills or get an x-ray. The copayment varies depending on what kind of medical service you want to get. For example, the copayment for refilling a prescription is small compared to the copayment for surgery. The higher your copayment, the lower your monthly copayment will be. If you have chronic medical issues, though, lowering the copayment in exchange for upping the premium may pay off in the long run.
What’s a deductible?
In the health insurance world, a deductible is the annual amount you have to pay to the hospital before your insurance kicks in. If you come down with cancer and you have a N500,000 deductible, for example, you’ll only have to pay a maximum of N500,000 toward paying for your treatment every year.