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health insurance design

How Health Insurance Design Affects Access to Care and Costs

By healthcare industry, healthcare price transparency

This is a guest post by Wendy Dessler from The Real Awards. Weighing The Pros And Cons Health insurance comes in many forms, some more popular than others. Essentially, it’s not always the rate you pay; sometimes the sort of coverage you get, the network where your coverage applies, and other collateral benefits may be more valuable than primary ones. You’ve got to weigh the pros and cons of different options in reference to your needs. The primary options right now are HMO and PPO plans. HMO stands for Health Maintenance Organization, and PPO stands for Preferred Provider Organization. Medicaid options are also available, there’s ACA coverage, and even a few non-traditional solutions like Medi-Share. Many of these provide similar coverage options through different avenues, but costs and health providers are of varying quality. HMO and PPO solutions tend to be popular in part owing to the larger networks members are able to utilize. However, this design means certain individuals may have greater difficulty accessing approved medical practitioners within a given network. Such individuals have to go outside an HMO’s network to get healthcare and lose the associated cost cushion.PPOs tend to have more extensive networks, so this isn’t so much of an issue, but they’re also more expensive than HMOs in general. You can follow the hyperlink for a deeper look into what differentiates HMO and PPO plans. Essentially, HMOs are more cost-effective but have greater network limitations, PPO plans are a bit pricier, but have better networks. Convenience Of Care Is A Big Factor In Choosing Your Provider There are situations where one of these alternatives will be more convenient for you. Medical institutions aren’t evenly distributed across the United States, and sometimes conditions can develop which may require specialized practitioners that are far beyond your network. The…

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