Please help me choose the right health insurance?
Question:
These two options are what I am considering:
Anthem POS High Option - $42.00
Aetna HMO - Ohio(EPO) - $36.00
The HMO seems to have better benefits (100% coverage after $250 copayment vs 90$ coverage after $250 copayment for hospital coverage, 100% coinsurance percentage vs 90%, both have no annual deductible for in-network). The HMO option also has no annual out of pocket maximum while the POS high potion has a $1200 annual OOP maximum.
Why is it that the HMO seems to have better options but costs less than the POS high option?
Answers:
With the HMO not only do you need a referal to see a specialist but you also need pre-approval from the insurance company before you receive almost any medical care. You must use a doctor or hospital in the network. If you travel outside of your area you may have a hard time finding someone.
The annual out of pocket maximum is actually a good thing. That is the most you will spend during a year for your health care. If you look at the summary of benefits you'll see that even though the HMO is at 100% you still have co-pays to pay for every procedure. These co-pays can add up to well over $1200 if you have major health problems.
Health insurance is tricky...trust me I verify benefits for a living! The bad thing about the HMO is you have to have a referral for every single thing except well woman/man visits. And I mean everything, if no you will get billed for it and it will be a large bill. But with the POS once you meet that 1200 OOP cost it will then pay at 100% and you dont need a referral. (Most of the time you'll only need a referral to a certain facility not for specific tests, appts etc.) A good way to go is to pick one this year and if you dont like it try the other one next year. Each one has good and bad sides so its your preference.
Plans will vary geatly based on the options and how many providers are in the network. Some have specific extra costs for out-of-network doctor coverage as well as referrals.
Sometimes, an employer will cover a portion of a healthcare plan and make it available to employees at a discount.
You should evaluate your overall health and decide which plan is right for your particular situation.
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I would suggest getting something like a discount program instead of insurance or to use on top of insurance. I use one that is awesome it covers my whole household and is very affordable, about $39.95 a month for all of this
Dental
Vision
Coast to Coast
Amerisight
Prescription
Medco
EZ Meds
Chiropractic
Physicians
Primary Care
Specialty
Hospital Advocacy
Mental Health
Let's Talk Counseling
several ntwk providers
NurseLine
Wellness Program
Infuse
Ancillary & Elective Services
Epic
Hear PO
AHAA
Cosmetic Surgery
Diabetic Supplies
Diagnostic Imaging Radiology
Physical Therapy
Astrum Hearing
Medstat
If you want more info on it you can go to
http://www.mybenefitsplus.com/kmile...
I hope this helps!
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POS, covers meds too
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