| One of the more annoying features of the insurance | | | | their patients to be reasonably healthy. The reason is |
| world is its habit of distilling options down to simple | | | | basic economics. Every physician has to meet a |
| sets of letters and then failing to clearly explain what | | | | quota of patients in a day. This means spending the |
| the letters mean. In other words, insurers hide behind | | | | shortest possible time on each consultation. Long |
| jargon and prefer not to explain clearly what you are | | | | diagnostic sessions disturb the quota and can result in |
| buying. You are expected to assume the insurer has | | | | penalties to both the doctors who miss their numbers |
| your interests at heart and pay over your money | | | | and the patients who have slowed down the queue. |
| without a second thought. In many cases it works. | | | | There are also significant restrictions on patient |
| Over the years, we have given up the unequal | | | | choice. A nominated primary care doctor decides |
| struggle and just say prayers we never fall sick. But, | | | | what referrals shall be made and to whom. HMOs are |
| as premium costs have risen and the recession has | | | | the cheapest form of care, but you have little control |
| cut back our spending power, trying to understand | | | | over the treatment you or your family receive. A |
| the options is back on the menu. So let's start with | | | | Preferred Provider Organization (PPO) uses the same |
| an explanation of HMOs and PPOs. In fact, they both | | | | basic approach but, because you pay more, you buy |
| rely on a network of physicians, clinics and hospitals, | | | | greater control over the treatment. The copayments |
| but they differ significantly in the detail of how they | | | | are around 20% and there are usually deductibles. |
| deliver healthcare to you and your family. A Health | | | | But, you have freedom to choose your own doctors. |
| Maintenance Organization (HMO) is a network of | | | | So long as you go see a physician in the network, |
| healthcare professionals that enters into a contract | | | | you are covered. If you want to see someone |
| with an insurance company. The insurer offers a | | | | outside the network, you usually only pay the |
| captive group of people to refer to the network and, | | | | difference between the network rate and the actual |
| based on the expected volume of business, the | | | | fees your choice collects. So, when it comes to |
| network agrees a fixed fee for all the main services | | | | cheap health insurance, an HMO is the better option. |
| on offer. In theory, this works well for everyone. | | | | But if you have the money and a health problem |
| The fees are discounted because of the volume of | | | | likely to need more extensive treatment, you should |
| business, so the insurer saves money and charges | | | | opt for a PPO. It always comes back down to your |
| lower premiums. This is usually the cheapest form of | | | | own personal needs and what you can afford. Cheap |
| health plan with very low copayments and, often, no | | | | health insurance always comes with limitations. Read |
| deductibles. But there are problems. HMOs are very | | | | the small print before you buy into any plan and see |
| reluctant to accept people with existing conditions | | | | exactly what you can and cannot do before you |
| requiring expensive treatments. They prefer most of | | | | agree to buy the policy. |