So Many Health Insurance Choices: Finding the Right Coverage for Your Business

Finding the best insurance coverage for your business can be tricky. As you navigate the insurance waters, you are sure to be confronted with multiple choices that all seem similar. Educating yourself and learning the features each plan offers will assist you in becoming your own best advocate. Today, more than ever, it is important to find the best insurance fit for you and your business.

An Unending Selection

Despite feeling like an unending selection, there are some main choices for health care insurance coverage. They are Health Maintenance Organizations (HMO), Preferred Provider Organization (PPO), Point of Service (POS), Managed Care plans and Fee-for-Service (or Indemnity) plans. Each is unique and offers a distinctive set of services.  

What Works for Your Business: Your Best Health Insurance Coverage Options

Knowing what each plan covers will assist you in making an informed decision. Each plan offers the following features:  

• Health Maintenance Organizations (HMO): HMOs are a classic health care plan where you pay a set monthly premium for a defined set of services. You must also be aware that there are two types of HMO models. One is a Staff Model HMO. This is where the physicians are employees of the HMO and they provide service from a medical facility. The other model is an Individual Practice Association (IPA). These are private practice physicians who have chosen to accept your particular HMO plan and you will visit them at their private offices. Most HMO plans have no deductibles and require a co-pay for office visits, lab visits, and pharmacy services. You will be required to select a primary care physician from an authorized provider and they will become your main point of contact. Any additional medical services will be provided from an authorized network of care providers. If you choose to use an out-of-network provider, you will not be covered except in emergency care situations. In this instance, if possible, it is always best to immediately notify your insurance provider to ensure coverage.

• Preferred Provider Organization (PPO): The Preferred Provider Organization is another example of managed care. There is a defined network of health care providers and you are eligible to select from this group. You have the option of receiving treatment from outside your network and in this instance; you will be required to pay a higher co-pay. Businesses who select a PPO plan for their employees can offer them a set monthly premium and like an HMO plan, your employees will have office, lab, and pharmacy co-pays.  
• Point of Service (POS): A Point of Service plan is a hybrid between an HMO and PPO plan and offers the flexibility of receiving care from a primary physician while seeing an out-of-network doctor. Members will be responsible for paying over and above a predetermined amount should they select an out-of-network provider without a referral from their primary care physician. Historically, POS plans cost more in monthly premiums, but provide the freedom to choose any doctor.   

• Fee-for- Service (Indemnity): Fee-for-Service plans offer consumers the ability to seek care from a vast selection of physicians. The provider will bill the insurance company and after your deductible is met, they will pay the bill. Typically, these plans are an 80/20 deductible plan. Employees would be responsible for the first 20% and insurance would cover the other 80%. This plan is not popular because of the high fees associated with it.  

Making the Call

Be your own best advocate and select an insurance plan that offers your employees the best coverage at the most affordable price. If you need assistance with finding the best plan for your business, Linton & Associates is ready to guide you to the most informed decision possible. Give us a call at 505.247.1530 and let one of our professional associates assist you with selecting the right health insurance for your business.