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Individual Health Insurance For Dummies Question & Answers

2015 July 22
by Sarah Fields

Robert asks…

what is an hmo and a ppo insurance?

im having a hard time understanding what an hmo and a ppo is, can someone please explain each of these and provide examples?

Sarah Fields answers:

PPO or “Preferred Provider Organization” plans are probably the most popular type of health insurance plan. With a PPO you’ll need to get your medical care from doctors or hospitals on the insurance company’s network of preferred providers if you want your claims paid at the highest level. It’s up to you to make sure that the health care providers you visit participate in the PPO. Services rendered by out-of-network providers may not be covered or may be paid at a lower level.

A PPO plan may be right for you if your favorite doctor already participates in the PPO network or if you want some freedom to direct your own health care but don’t mind working within a list of preferred providers.

HMO means “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members. As a member of an HMO, you will need to choose a primary care physician who will provide most of your health care and refer you to HMO specialists as needed. Health care services obtained outside of the HMO are typically not covered, though there may be exceptions in case of an emergency.

An HMO plan may be right for you if you’re willing to play by the rules and coordinate your care through a primary care physician. It may also be a good choice if you value preventive care services: coverage for checkups, immunizations and similar services are often emphasized by HMOs.

If you’re looking for some more definitions and tips on health insurance shopping, request a free copy of the book we recently published, “Individual Health Insurance For Dummies.” You can get a free electronic copy or have one mailed to you here:

Best wishes.

Sandra asks…

can some one help me to find a health insurance?

i am 24 years old male i need a health insurance that cover a physiatrist

because i have depression
i found to many plans i did not know which one should i choose!goToScreen?screenName=best-sellers


Sarah Fields answers:

It can be hard to pick the right plan, and the fact that you may already have a diagnosable condition could potentially complicate things when it comes to applying for coverage. I’d recommend that you contact a licensed agent by phone to get some personal advice.

Local licensed agents in your area are a great option. But despite what one of your other readers said about us (mbrcatz usually gives great advice, by the way), we like to think our licensed agent at eHealthInsurance are great at their jobs and perfectly capable of giving you the kind of help you need. Please feel free to give us a call, or talk with a licensed agent in your area. Whatever you prefer, so long as you get the help and the coverage you’re looking for!

Since it sounds like you’re new to buying health insurance on your own, you may also want to check out the “Individual Health Insurance For Dummies” book that we recently published. We’re giving it away for free in both print and ebook formats right now:

Best wishes.

Betty asks…

Can somebody Explain Obama Heath care plan for a dummy?

Sarah Fields answers:

There are several proposed bills working their way through Congress. The first link below summarizes some provisions of one of the major ones, the House Bill HR 3200. The second link is to a .pdf summary of the Senate Finance Committee bill, aka, Baucus bill.

Essentially, the bills provide for universal health care coverage through insurance companies. The House bill includes a public option, which would give individuals and businesses the option of choosing a government-run program instead of those offered by the private insurance companies. Coverage is mandatory with subsidies for individuals who cannot afford to pay the premiums.

The bills create health insurance exchanges where businesses and individuals can shop for insurance. People with pre-existing conditions can’t be excluded and there are coverage standards that insurance companies have to meet.

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