Health Insurance

Individual and Family Health Insurance Plans

With Health Care Reform and the Affordable Care Act (ACA) now under way, navigating and understanding your health care options has never been more crucial. Depending on each individual’s unique situation, there can be several choices. Changing rules and regulations, health insurance plan designs, and avenues to purchase insurance can make it a confusing decision to make on your own. If you’re looking for coverage for yourself and family let one of Fullhart Insurance’s helpful agents assist you in selecting the best plan, either direct from our carrier partners or through HealthCare.gov.

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We’re here to help you find the best coverage, without the headache. Before getting started, it’s best to determine your budget, your health requirements, your physician, and your personal approach to healthcare. Combining these factors will help us uncover the perfect health insurance policy for you and your family.

It’s important to know the difference between the various organized medical networks when you are looking for health insurance:

HMOs

The lowest cost option of these networks is the HMO (Health Maintenance Organization). HMOs are set up in regional clinics where you will need to go to visit your primary care physician’s (PCP) office, so you’ll want to make sure the facility is close to your home. HMOs are often a good choice for families who are healthy and only require mostly routine care. Typically they don’t require a deductible, and co-payments are minimal.

HMOs typically offer less flexibility in choosing a physician and hospital than other health insurance plans. Another drawback is that you will need a referral from your PCP (Primary Care Physician) before you can see a specialist. It’s also important to note that there is typically no coverage for services performed by non-network providers or without a proper referral from your PCP.

PPOs

Slightly more expensive than HMOs, PPOs (Preferred Provider Organizations) offer more flexibility in your choice of physicians and hospitals. PPOs normally don’t require you to pick a PCP. Instead, you will be able to see doctors and specialists within the network at your discretion. If a family member needs to see a specialist, PPO health insurance plans provide a large network of doctors to choose from, and they will cover some of the costs at a lower percentage if you need to go outside of the network.

POSs

A POS (Point of Service) offers a combination of the HMO and PPO plans. As with an HMO, POS members are required to choose a PCP from the plan’s network of providers, and services provided by your PCP usually don’t require a deductible. Also, like HMOs, POS health insurance plans often cover 100 percent of preventative care visits.

However, this higher level of coverage is generally for services carried out or referred by your PCP. Services provided by a non-network provider may require a deductible and will likely be covered at a lower percentage. If services are provided outside of the network, you’ll likely have to pay up front and submit a claim to the insurance company yourself.

HSAs

HSAs (Health Savings Accounts) became effective in 2004 and offer a tax-free option for paying your family’s health costs. They also have the added benefit of being a possible tax-free savings account. An increasingly popular option, an HSA is a tax-favored savings account that may be used in combination with an HSA-eligible high-deductible health insurance plan to pay for qualifying medical expenses.

Choosing an HSA-eligible health insurance plan may help you save money. The monthly premium on an HSA-eligible high-deductible plan is often less expensive than the monthly premium for a lower-deductible health insurance plan. Another benefit is that contributions to an HSA may be made pre-tax, up to certain annual limits. Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year to year, tax-free.

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