WPS Health Insurance Blog

How to avoid surprises from your health plan, part 2: Understand your needs before you buy

Posted by Ryan Kanable

Mar 26, 2013 9:00:00 AM

High medical billHave you ever been surprised by a health care bill? How about with the features of your health plan? Here are a few suggestions about how you can avoid surprises from your health plan. This is the second post in a series about things you can do to prevent the unexpected. You can read the first post for more tips.

When choosing a plan, find out which plan type truly meets your needs. Did you know that there are many different types of health insurance coverage? Not understanding the difference between HMOs, PPOs, and POSs could bring unwelcomed surprises down the road. So take some time to determine which plan type truly meets your needs before you buy.

A quick overview

A Health Maintenance Organization (HMO) requires that you use doctors within a specific network, which gives you less flexibility but saves on cost. It requires a referral from your primary care physician if you need to see a specialist.

A Preferred Provider Organization (PPO) allows you to see doctors in or out of the network. Out-of-network care requires you to pay a higher percentage of the costs, however. Also, you don’t need a referral to see a specialist.

Point-of-Service (POS) plans combine elements of HMOs and PPOs. They offer the option of going out of network, but usually require that you have a primary care doctor within the network and that you get a referral before seeing any specialist.

Other options

You may also want to consider opening a health savings account (HSA) or contributing to a flexible spending arrangement (FSA) to help pay for your medical expenses. Both let you use pretax dollars to pay for prescriptions, contact lenses, and other medical bills. There are pros and cons to both, so do your homework before opting for one of these options.

For more information, take a look at WPS’ brochure on Top Tips for Buying Individual Health Insurance.

Topics: health insurance