Health Insurance in Monticello, GA

What is a Preferred Provider Organization?

A Preferred Provider Organization (PPO) is a type of health plan that uses a network of providers such as doctors, specialists and hospitals.  Generally, referrals are not required and you may be able to get care outside of the network, usually at higher costs.

What is a Health Maintenance Organization?

Health Maintenance Organizations (HMOs) are health providers that may require a referral from a primary care doctor to see specialists or other providers. Since an HMO is usually an in-network plan, an insured individual may not be able to get care outside of the plan’s network.

What are Traditional Fee-for-Service Health Insurance Plans?

A fee for service plan (typically Medicare) means that an insured party may receive health care from any provider, as long as that doctor or facility agrees with the plan’s terms and conditions for payment. An insured party with a Fee For Service Plan may be subject to getting the balance of the bill not paid by the insurance plan.

What are Point-of-Service (POS) Plans?

A Point of Service plan is generally an HMO that allows an insured party to seek care from doctors or specialists without a referral.  In some cases, an insured party may be able to receive care from outside the plan’s network.

What are Supplemental Health Plans?

Supplemental Health Plans are generally policies purchased from an insurance company to cover a variety of different occurrences such as:

• Critical illnesses plans, for such events as a heart attack or stroke.
• Cancer plans that pay a specific amount of money when an insured party is diagnosed with cancer.  The funds are paid out to alleviate the costs of treatment.
• Hospital indemnity plans pay a specified amount to an insured party for hospital stays or outpatient surgery to offset out of pocket costs like deductibles or co-pays when used in conjunction with a health insurance policy.

What is The Difference Between Traditional and Group Health Insurance?

Traditional or individual insurance are plans offered by private insurance companies.  The premiums are usually paid by an individual directly to the insurance company.  Group insurance offers an employee health insurance at a reduced rate for the employee.  Bear in mind that group policies may not offer the family members of the employee the same reduced rates.  Usually, an employee has to pay the normal price to include dependent children or their spouse on an employer-sponsored health plan.

What is The Best Type of Health Insurance for Chronic Conditions?

Any “credible” health plan has to cover pre-existing conditions per the Affordable Care Act. A credible health plan is a health plan that does not exclude pre-existing conditions or imposes a maximum amount of coverage (i.e. $1 million of health care coverage).  Credible plans must also cover preventive screenings, such as annual physical exams, mammograms, vaccinations, etc.

What is Obamacare?

Obamacare is another name or term used for health insurance offered through the Health Insurance Marketplace. The “Marketplace” offers health coverage to individuals and families, often at a reduced rate, typically lower than buying a plan directly from an insurer. The difference is that eligibility for financial assistance may depend on various factors such as age, income, and geographic location. Insurance is usually offered until an individual turns 65 years old.  After age 65, in most cases, an individual is no longer eligible for an individual health insurance plan. There are certain circumstances where an individual 65 or older may be able to stay with an individual plan, such as employer or group insurance.

What is Dental Insurance?

Dental insurance may vary from company to company.  However most dental plans offer coverage for cleanings and basic services, such as non surgical extraction or a filling.  Some dental plans cover major services such as coverage for crowns, root canal, oral surgery, etc.  Dental plans may be offered as an HMO or a PPO.  Some employers may offer dental coverage along with health insurance and vision coverage as a package.  Most dental plans offer a yearly limit of coverage such as $1000, $1500 or $2500 and plans may or may not to cover orthodontics (braces).

What is Vision Insurance?

Vision Insurance offers coverage for eye exams or coverage (or allowances) for eyeglasses or contact lenses.  There are certain plans called Flexible Spending Accounts that allow you to save pre-tax money into an account to pay for dental or vision expenses. FSAs are usually allowed with employer or group insurance plans.

What is a Copay?

A copay (copayment) is a fixed fee that is paid by the insurance provider.  Copays help reduce medical costs for those who are insured, like the cost of a doctor’s visit or medication.  Copays are paid at the time of the medical service, like during a doctor visit or when you get your medicine.  Some plans don’t provide copays, while others use copays in addition to deductibles and coinsurance.

What is Coinsurance?

Coinsurance is a percentage of medical cost that you pay after you’ve met your deductible.  The general concept of coinsurance is that the insured individual and the insurance carrier shares the cost of the service or medication.  Typically, If one hasn’t paid his deductible yet, he would pay the full cost until his deductible has been reached.  When reading one’s coinsurance percentage, a higher coinsurance percentage means a higher share of the service cost that one must pay.  The insured individual is also responsible for any additional charges that the insurance company’s plan doesn’t cover or share.

What is a Deductible?

A deductible is a yearly total amount that an insured individual must pay before the insurance company shares the cost for covered services or medications. The amount you pay depends on the type of plan that you choose, but in-network services typically have lower deductibles than out-of-network services.

When choosing a deductible amount, it is best to consider the chances of your needing to use the insurance plan.  If the plan is more likely to be used, a lower deductible and a higher premium might be best.  On the other hand, if the plan is not expected to be used, a higher deductible and lower premium might be best.