Questions to Ask Your Agent

Does a PPO or HMO provide more coverage?

A health maintenance organization (HMO) consists of a network of doctors and other types of health care providers who offer their services at a fixed rate. You may only visit an out-of-network provider for an emergency and in other special circumstances. You will be asked to choose a primary care physician who you must get a referral from to visit a specialist.

A preferred provider organization (PPO) is quite similar as some of the doctors and health care providers belong to a contracted network and offer their services at contracted rates. However, there is more flexibility with a PPO as you can visit any doctor and health provider you like. It will generally cost you more though if the provider doesn’t belong to the network.

PPOs just provide more coverage when it comes to out-of-network providers but HMOs are more affordable.

How can I get lower monthly premiums?

You can usually get lower monthly premiums on health care plans if you have a higher deductible amount. This is a total amount of money that you need to pay out of your own pocket before the insurance coverage starts. For example if your deductible is $2500 a year, you need to pay this amount for medical care before your coverage will kick in.

You should also get lower premiums if you are in generally good health and don't smoke. This means you are seen as a lower risk to get ill by health insurance companies.

Also, you can typically get lower rates if your copayments are or coinsurance rates are higher. For example instead of paying 20 percent of costs, you could pay a higher amount and get lower premiums.

What isn't provided by my policy?

Most health plan policies are unique. Even though they may fall under the same category and title, you will generally find that no two policies are exactly the same. It is important that you know specifically what the plan covers and what it doesn't cover before deciding which one to take. Don't be afraid to ask questions about the policy to have everything clarified to you.

Talk to an insurance agent so you know if the policy fits your health and financial needs.