How to Keep Your Doctor and Still Get Affordable Health Insurance

By Compuquotes Team on September 24th, 2008

Health Insurance

One of the most difficult choices your family may face when you change jobs is whether to fire your doctor or keep him and pay more for medical care. Many health insurance plans are very picky about the health care providers with whom they work. If you're facing a decision that forces you to choose between your family doctor and a health insurance plan with lower premiums, don't despair. There is a choice that may allow you to have both. Here's a quick rundown on the most common types of health insurance plans, and how each will affect your choice of medical providers.

Indemnity Health Insurance Policies
Indemnity health insurance plans are "traditional" health insurance, like Blue Cross Master Medical insurance. Indemnity policies offer you the most flexibility in choosing health care providers, but that often comes at an added cost, not only in premiums but in deductibles and co-insurance payments. Most indemnity plans allow you to choose any doctor, hospital or health care provider for your care. Typically, there is no 'gatekeeper' to qualify your health care decisions. You choose the doctors and providers that you want.
Cons: Indemnity policies are typically the most expensive type of policy. In addition to paying higher premiums, you may also be required to pay a deductible, and then a co-pay before your insurance company kicks in. For example, if you visit your doctor for a procedure that costs $800 and you have a deductible of $200 and co-pay of 20%, you'll have to pay the first $200 plus 20 percent of the remaining $600. Your insurance company will pay the remainder. In addition, indemnity policies often don't cover wellness care or preventive health care, though this is changing as insurance companies realize the savings in health care costs.

Health Maintenance Organizations
HMO's have been growing in popularity since their introduction about fifty years ago. The original impetus behind the HMO concept was the idea that it is less expensive for the insurance company to pay for preventive and routine medical care than it is for them to pay for health care with routine care is neglected. Typically, HMO's will allow you to choose or assign you to a primary care provider who will 'manage' your health care needs. The PCP serves the same purpose as the old family doctor, providing primary health care and referrals to other medical services and specialists as needed. In that way, the primary care provider serves as a sort of gatekeeper, a single source who knows your medical history and makes recommendations and referrals based on that history.

HMOs are typically the least expensive health insurance plan based on premium, deductible and co-pay. With most HMO's you will pay a standard co-pay for all office visits, whether it is to your primary care provider or to a specialist. Rather than a deductible, you will usually be responsible for a co-pay if you make an emergency room visit, and for any hospitalization.
Cons: With an HMO, you have very limited flexibility in choosing your own health care providers. The HMO will generally only pay for medical consults and care that is ordered by your primary care physician. Your choice of hospital and clinics will also be restricted to those within the plan. If you choose to see someone without a referral from your primary care provider, you'll foot the entire bill yourself.

Preferred Provider Organization
Preferred Provider Organizations are hybrid indemnity health plans that offer you much of the flexibility of a standard indemnity plan at a lower cost. Generally, a PPO is organized by an insurance company. When you join a PPO, you'll get a list of 'preferred providers' in the network. If you choose a doctor within the preferred provider network for your medical care, you'll pay a standard co-pay, and usually a percentage of the bill as a deductible. You're free to choose a medical provider who is not a member of the network, but you'll pay a higher percentage of the bill and a higher co-pay when visiting a doctor outside the network. PPOs generally have lower premiums than standard indemnity plans, and many include preventive health care services as well as some prescription coverage.

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