Health Insurance Plans

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Health Insurance Plans

• Ashley Lee Willis
• April 24, 2007

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What is a Health Maintenance Organization? (HMO)

• In order to receive the benefits of an HMO an
  individual must pay a fixed monthly amount .
• With an HMO plan one may choose a primary care
  physician from an approved list of doctors.
• An individual may not visit other specialists
  without the consent of their primary care
  physician
• Visits to doctors or specialists who are not
  approved through the primary care physician, or
  who are not on the approved list, will not be
  covered.
• Most visits require a co-pay ranging from 5-20.

(http//www.healthinsuranceindepth.com/policy-type
s-hmo.html)
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What is a Preferred Provider Organization? (PPO)

• In order to be a part of a PPO an individual must
  pay a monthly fee that will then allow them their
  choice of providers, and a network of basic
  medical benefits.
• With a PPO a primary care physician is not
  required, and as a result, seeing a specialist
  does not require a referral.
• If an individual prefers to receive health care
  outside the providers offered, they should expect
  to pay a higher co-payment than if the provider
  were from within the PPO network.
• Essentially a PPO provides an individual the
  freedom of choice when visiting a doctor or
  specialist by cutting out the middle man.

http//www.healthinsuranceindepth.com/policy-types
-ppo.html
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What is a Health Savings Account? (HSA/HDHP)

• Health Savings Accounts (HSAs). A personal
  tax-exempt trust account designed for the purpose
  of paying for medical expenses.
• Money is contributed by individual and employers
  tax free
• Users can only qualify for an HSA if they are
  enrolled in a High Deductible Savings Account
  (HDHP)
• Money in an HSA account can be used for
  "qualified medical expenses" which include
  expenses for "diagnosis, cure, mitigation,
  treatment, or prevention of disease." (Tech Ex p.
  73)
• The money in an HSA can provide coverage during
  periods of unemployment, medical expenses after
  retirement and long-term care expenses.

http//www.nahu.org/legislative/HSAChangesChart.pd
f
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Problems Getting Care
Source Consumer Reports
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Billing Hassles

• HMO 15 of holders reported having billing
  problems
• PPO 32 of holders reported having billing
  problems
• HSA/HDHP No billing hassles

Source Consumer Reports
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Cost Analysis

• Top five expenses Americans incur each year
• Health Care Expenses increase annually almost 10
• Employers will be unable to subsidize the cost of
  Health Care

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Cost Analysis
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HSA/HDHP Wealth Accumulation
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Our Recommendations

• HSA Healthy family who only anticipates routine
  health needs
• PPO Health care needs which requires
  specialists
• HSA/HDHP Single and healthy