It is as important to know the type of medical health coverage plan that you signed up for as having the coverage itself. Not knowing your coverage is like traveling cross country without a good blueprint. You wouldn’t know where you are going or even the direction you should travel. So for the sake of yourself and the family members that depend on you, originate sure that you find out as powerful about your type of plan as possible.

There are many plans available. Some types of plans have been around for years while other types of plans are either a hybrid of an archaic plan or something completely original. As a member of an insurance plan, you are responsible for shimmering about your and most customer service representatives that you will speak with at the insurance company will try to give you as mighty education as possible. You as the member do not have a limit on questions you can ask. Ask questions even if you think it is a stupid question, it is better to know the answer to your query from the insurance company that to be wicked. Remember, if your question was not answered to your satisfaction you can always call back the insurance company and ask your ask again. Chances are you may derive a different person who can answer your quiz in a different way that you will understand. This is only a short explanation of each plan. Read over you plan booklet to get a total in-depth knowledge of your belief coverage, any exclusions and limitations.

Remember that your total health plan (medical, dental, vision and prescription) may have been purchased in a bundle. Different companies may run one specific portions of your plan. Let’s go over your medical plan first. The medical plan is a lot like ordering a hamburger. There are a lot of different ways you can derive your burger by looking at the menu. You get the main burger but you can always add on anything you want for a little extra. These extras that are added on are called riders. But to trick you up sometimes these extras are part of the main menu item. (This is why some plans are more expensive than others. If you had a lot of young women working for you maybe you would like to make sure that everyone had infertility coverage as section of the basic coverage. If you only had senior citizens working for you would you really want to conceal maternity and well baby check ups? Maybe not but you would want to mask something special like hospice or respite care. Hence getting the most basic package and adding on to it with a rider.)

Sometimes different plans may masquerade under the acronym MC for Managed Care. Some companies had dropped the name Managed Care as a plan name. Other companies used the name Managed Care to group types of plans together and some states require this name based on the type of plan that is being sold. HMO plans and POS plans are Managed Care Notion based on the face that you have to follow a chain of command for health-care. This led to mass confusion for both the members and employers hence the Manage Care Plans became a grouping of thought types under this heading that required you to follow a chain of jabber. Let’s go over the top three plans, look to the descriptions below to discover a more in depth description of each plan.

HMO is a Health Maintenance Organization. Doctors or health-care providers who wish to see members with an HMO conception must heed a contract with the insurance company to accept the care their members. The doctors or other health-care provider negotiate rates of payment for all service that will be provided to the members of an insurance company. There are a lot of rules and regulations that the contracted providers must follow from filing the bills to following a chain of command for seeing the insurance company’s members. The doctors must follow a set of care guidelines that include referring the insurance company members to only doctors, hospitals or other medical service providers who have signed a contract with the insurance company. There is a structured chain of command that the members also have to follow. Mostly, the member (that is YOU) must choose a doctor (also known as the primary care provider or PCP) to be their health monitor (also know as a gatekeeper). When ever the member (you) need any medical assistance, you must go to your primary care provider. This often includes: routine health exams, annual physicals, immunizations and sick visit. If you require specialty care, then your primary care provider must refer you to a specialist, hospital or other medical provider of service. You may not go to a doctor or medical provider that has not signed a contract with your insurance company nor can you just go to a medical provider if you have not been referred by your primary care physician. If you do go to any medical provider without a referral or have any medical services that are not authorized by the insurance company, you will be held financial responsible for those charges. The same can be said about have services authorized by the valuable care physician. An authorization is different from a referral. The doctor is sending you to only be seen by another medical provider is a referral. If a medical provider wants to do something to you such as tests, procedures or products that will be given to you by the medical provider the insurance company must give the go ahead before the services can be done, this is the authorization. If no authorization is given you can be held financially responsible for the cost of the test, procedures or products that you were given suitable down to the last Band-Aid. The plan may have a fixed dollar amounts called co-payments (also know as co-pays for short) for medical services or it may be a fixed percentage (called a co-insurance) for the services. Sometimes you may see both on the belief. You may also see a maximum dollar amount that the play will pay for definite services in a given year or for the lifetime of the conception. Always know that you may not have mental health coverage unless it is spelled out in your benefit listing. You may also have a deductible; most HMO plans do not have this, which is a fixed dollar amount that you are responsible for before your plan will start to pay. You may have other restrictions such as a lifetime dollar maximum the plan may pay for your care. But on the plus side you may have a co-pay or co-insurance calendar year maximum (this spend to be called an out of pocket maximum). When this co-pay or co-insurance maximum is met you pay nothing else for the rest of that year.

PPO is a Preferred Provider Option. You are not required to have a specific primary care physician. Nor do you need a referral to see a specialist, ever. You can change your doctors at anytime. That is the true freedom of this plan. But be forewarned it is up to you and you alone to make sure that every doctor, hospital and medical provider is contracted to your insurance company if you are using your in network benefits. Any error on this part will be considered yours even if you were referred to an out of network medical provider. Like the HMO notion, distinct services and procedures will still require authorization from the insurance company. But instead of this responsibility falling to the medical provider, it now falls to you. (Yeah, with big freedom comes the big responsibility that falls squarely on your shoulders.) This plan will have a deductible, which is a fixed dollar amount that you are responsible for before your view will start to pay any bills. You may see doctors who have a contract with your insurance company or you can see a doctor who does not have a contract with the insurance company. This allows you a lot more freedom on who you can examine but it comes at a ticket. If you exhaust a medical provider who is contracted to the insurance company, you are using your In Network benefits. The deductible is normally lower when you see a medical provider who is contracted to the insurance company. The co-insurance amount (or the percentage of the bill that is your responsibility) is usually lower as well. This means less money coming out of your pocket because the contracted medical provider is giving a discount to the insurance company. The insurance company passes this savings on to the member. The reverse happens when the member uses a medical provider who does not have a contract with the insurance company (also know as the Out Of Network benefits). The deductible is normally higher than, sometimes three times as high as your In Network deductible and the co-insurance percentage of coverage amount is lower. Since there is no savings to pass on to the member the insurance company will only pay a reasonable rate or fee (sometimes Medicare rates are archaic for the reasonable rate while the fee can be anything from what the insurance company normally pays its contracted doctors to a rates that are purchased from a company that compiles this information and mathematically figures out the reasonable fee that doctors in that area of service charge. The way that the reasonable rate is figured varies from area to area and insurance company.) The reasonable rate is not always the same amount the medical provider of service may charge. The member is responsible for any amount that the insurance payment does not cover. In fact you can resplendent much forget the co-insurance percentage that the insurance company should have paid. Here is an example: Doctor B charges $50.00 dollars for an office visit. The fee that is considered reasonable is $25.00 dollars. The insurance company paid $15.00 dollars to Doctor B. This means that the member is responsible for everything not paid for by the insurance company which is the balance of $35.00 dollars. This is a penalty to the member for not using a contracted provider of medical service. You may also have a restriction such as a life time maximum payout on this plan. Your deductibles for in network benefits and out of network benefits may be totally separate from each other. What was $250.00 dollar for your in network deductible and a $500.00 dollar out of network deductible is really a total of $750.00 dollars deductible if you use both options. The same could happen with your in and out of network co-insurance as well as any out of pocket maximums.

POS is Point of Service Plan. This is a hybrid of a HMO plan and a PPO plan spliced together. You must have a primary care physician who is responsible for referring you out to any specialist. If you choose to follow the HMO chain of command you will only have your co-payments or co-insurance when you stay within the confines of your HMO. But let us say that you heard of a special doctor or your indispensable care physician will not refer you out to a specialist. You can self refer yourself to the specialist. That is because this plan allows gives you a PPO plan to spend at any time. Since you have the PPO benefits available your primary care physician will always document who you were referred to, when and of course your referral will always be to a contracted provider. When you decide to use the PPO part of your plan you must inform the doctor you are self referring yourself. You follow the PPO guidelines for seeing a medical provider of service that has signed a contract with the insurance company (using your in-network benefits) or you may expend a medical provider who is not contracted (this is using the out of network benefits). Authorizations for definite services and procedures are still the same regardless if using the HMO or PPO portion of you benefits. Read both the HMO and PPO paragraphs above to get more detailed information of the plans. See the restrictions to co-insurance, co-pays and lifetime maximums on both the HMO and PPO listing above.

This is not a listing of all plans available. You may also see Indemnity plans (which is the granddaddy of the PPO opinion) with only one type of deductible and co-insurance payable no matter if the doctor or medical provider of service is contracted to the insurance company or not. Unfortunately, if the medical provider is not contracted with your insurance company you are still responsible for payment on anything over the reasonable rate that the insurance payment did not camouflage. Health Funded Plans such as Health Savings Accounts (HAS) & Health Reimbursement Arrangement (HRA) have restrictions that require the health plan you to have special types of edifying opinion that has a very high deductible and even special funding by the employer.

Don’t be afraid to ask questions to your employer or human resource office if you are unable to get answer from the insurance company during open enrollment. Your employer can usually catch a representative to call you directly if you are unable to get answers through normal channels. Make notes about the type of belief that you currently have to the difference of benefits that the new plan is offering. Make sure that you are getting the best coverage for your level of health. Nothing is more of a drain on your pocket book than having a surprise pop up like cancer or another debilitating illness that can kick off the high deductible on your thought that will financially cripple you. When you are that ill you have more important things to pain about that your finances.

For months now, the “debate” on health care has stirred up fears amongst both sides of the largest ideologies. Those who want a public option or at the very least, real reform of our health care system, are worried over the possibility of change not taking location. Those who claim to like the current system the way it is, fear the word socialism and the chance that it may find its way into our health care. Some are even so blinded by fears of socialized medicine that they shriek, “Keep your hands off my medicare” toward representatives at town meetings, unaware that their medicare, which they rightfully appreciate, is a social program and has been for over 40 years.

The clearest answer as to why these fears are so pervasive is simple yet, nothing new, and the fears become the mechanism that keep reform from occurring. Propagandists have touted socialized-medicine-fear-mongering since Harry Truman first tried to establish a national insurance program for adequate health-care for all, but the American Medical Association, joined by conservative Republicans and Democratic sympathizers, called the progam “Socialistic.” Opponents continued this offense through the failure of Hillary Clinton’s push for reform in the mid-90’s. The goal of ‘The Task Force on National Health Care Reform’ was to provide universal health-care for all Americans. Propagandists and Republican opponents of the reform maligned it as heavily bureaucratic, and dismissive of patient choice, but a republican’s view of patient choice is tantamount to a citizen deciding if, or if not to go to their doctor or hospital. Our system today is devoid of patient choice, even doctor choice. HMO’s are the decision makers, not the doctors and patients. A single payer health care system would remove this sinister, profit-motivated routine from the picture. Everyone would be in, and nobody would be out.

Our current president, Barack Obama, was originally involved in transcending our for-profit system into a single payer. In 2003, while speaking to the Illinois AFL-CIO, Obama stated “I happen to be a proponent of a single payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to examine. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take befriend the Senate, and we have to take back the House.” Well, the Democrats have taken back the White House, but Barack’s position has been modified.

Since the debate over health care reform has begun (once again), the issue of ‘why not single payer? ‘ has come up, and Obama’s space has been to lay out his belief in a single payer health care system from the foundation of a nation. If we “were just starting from scratch,” single payer would be the right idea. The end result is a president, who once believed and stood for a single payer system, now laboring under the delusion that the single payer system would be “too disruptive.” He has elaborated on the concept by stating, “A lot of people who currently have employer based health care would earn themselves dropped and they would have to go into an entirely modern system that has not been set up yet. I would be concerned about the potential disruptiveness of that kind of transition.” One would think, logically, that a real misfortune would be the amount of jobs that would be lost by putting companies like Aetna, UnitedHealth, and other insurance giants out of business. Personally, I’m all for it. I do not see the pragmatism in keeping useless, self-serving industries alive while thousands die every year, and millions suffer, day after day, without adequate health care.

Real reform demands radicalism, otherwhise, the proponents of repression are given more than enough time to shift gears and near out on top. Furthermore, “radicalism” does not necessarily translate to “irresponsibility.” Responsibly, the removal of for-profit companies from our hair would be a packaged deal with robust unemployment compensation for all workers, job-training, and of course, single payer health care. How is this “disruptive,” when we have an insurance industry that is the direct cause of some 20,000 deaths a year, 50% of all bankruptcies, and is costing us billions more than comprehensive health care needs to? People are scrambling to fabricate ends meet as insurance premiums continue to increase. Bureacracy is rampant in our current system because of the decisions surrounding whose claim is covered and whose is rejected, and we’re afraid to cover everyone through one provider (the federal government, in other words, us), because of fear mongering that leads us to believe that the only alternative is a socialized alternative that precludes patient choice. The debate, or pseudo-debate, is what’s really disruptive. It is disruptive of progress.