Between the months of October and February, Balanced Care works with each of our group employers looking at their current coverage, seeing if any changes took place during the year with employees, and lastly, begin to look at their next year’s options. Every year questions are asked about the different plans that are available. Let’s take a look at the different plans so you can start to understand what will work best for you and your employees.
HMO (Health Maintenance Organization) – With this type of plan, you choose a primary care physician from your plan’s network. That physician will direct your medical care and provide referrals for a specialist should you need one. With an HMO, you must go for your medical care within your plan’s network or your care will not be covered unless it is an emergency medical situation. With an HMO, you normally will pay a co-pay when services are rendered such as a doctor’s visit. The advantage of an HMO is that you will work with the same physician who knows your health the best.
PPO (Preferred Provider Organization) – With this type of plan, you can visit any doctor in or out of the network. There is no referrals needed before going to a specialist and you don’t have to choose a primary care physician although physicians and insurance companies do recommend it. When it comes to cost, it works differently than an HMO. Normally, you will pay a percent of the bill called a co-insurance. For example, you pay 20% and the insurance company pays 80%. If you go out of network, your cost may be higher than in network. The advantage of a PPO is having the flexibility to go to any physician without a referral or having to depend on a primary care physician.
HRA (Health Reimbursement Arrangement) – This is a fund that works with both a HMO or PPO plan. An employer will put funds into an account that you will have access to pay for your deductibles, co-pays, and other health care costs that you normally would pay out of pocket for. The funds will roll over from year to year as long as you remain in the plan, however, if you change plans or leave the company, the funds do not come with you. The advantage of an HRA is your out of pocket costs each year will be less as the employer helps to pay for health care costs.
HSA (Health Savings Account) – This is an account paired with a high deductible health plan. The premium you pay for this type of plan is normally less expensive than other types of health plans. You can put money into a separate account that has not been taxed. Both an employer and an employee can fund the account. The money that is in this account can be used for eligible health costs such as deductibles, prescription drugs, dental, and vision. If you don’t use the money in a calendar year, it will roll over and it remains yours even if you leave the company, however, it still must be used on health care expenses. The advantages of a HSA is that you pay no taxes on the money put into a HSA, it grows and can earn interest year after year, and you can take it with you if you change plans or companies.
Before you sign up for a new plan, we encourage you to call us so that we can sit down together and go over your options. Our expertise is in finding a plan that takes into account your budgetary requirements, matches coverage to your unique needs, and helps you to retain your valued employees. So whether you need a HMO, PPO, HRA, or HSA, we will work together so that everyone understands the plan and how it can work to your advantage.
Terri Trepanier is the Owner of Balanced Care and a licensed insurance broker in New Hampshire and Maine. Located in Rochester, NH, she specializes in helping individuals and businesses with their Health Insurance, Dental Insurance, Life Insurance, Disability Insurance, Long Term Care Insurance, Medicare Supplemental, Medicare Prescription Drug Plans, Accident, Critical Illness, and Cancer Plans. Terri knows the importance of insurance products and how they help individuals and families. She continually strives to give her clients the Peace Of Mind that each of us deserves.
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