Major Medical Insurance Plans

As the name implies, major medical insurance plans offer the best protection for individuals and families and if you're looking to purchase a policy, there are many things you'll need to consider. 

While these types of health insurance policies provide coverage for most of your medical expenses, there are certain amounts you may still be responsible for paying such as any co-pays and deductibles depending on the plan you choose. There may be other limitations that apply but for the most part major medical insurance plans cover the bulk of the cost for most treatments or hospital stays. In order to keep the health insurance policy affordable you may elect to pay a deductible and co-pays when you visit the doctor. Each program varies a little bit, but they all have similarities. 

Major medical insurance plans are very important and play a critical role in or lives – especially when we need them. Most people aren't in a position financially to pay for every visit to the doctor, and this is especially true if you have a hospital stay or need a surgical procedure. Many employers offer health care as a part of their benefits package and are the number one place people get health insurance in the US. But what if your employer doesn't offer employee health insurance or what if you're not employed? Insurance companies offer private health insurance plans but if you're not sure what to look for in a health insurance policy, you may end up either paying too much or getting too little coverage. The reality however, is that there are many people in the United States that have no health insurance coverage whatsoever.

There are many different options when it comes to purchasing medical insurance. The most common plans are HMO and PPO plans, and although the coverage is very similar, there are differences you’ll need to understand so you can choose wisely between the two. 

Health Maintenance Organization (HMO)

HMO's or Health Maintenance Organizations are typically less expensive than PPO's and are able to offer major medical insurance coverage at discounted costs because they work with a pre-defined network of participating medical providers. In other words, you are limited as to which providers you can choose from. You will need to find a primary care doctor who is part of the network of participating physicians and can choose from many pediatricians, internal medicine physicians, and family physicians. Your primary care physician will have to give you a referral if you need to be seen by a specialist. Without a referral, the costs can be quite high and in some instances, may not cover all your expenses if you did not get a referral. One of the biggest advantages with an HMO is that you will never have to file your own claims. 

Preferred Provider Organization (PPO)

A PPO or Preferred Provider Organization, offers the same type of major medical insurance plans as HMO's but with fewer restrictions so you'll have a bit more freedom with your selection of providers. You will be able to choose one of the physicians that are in the preferred network and will not need to have referrals to be seen by a specialist. However, if you were to choose a physician that is out of network, your out-of-pocket costs may be a bit higher. 

In deciding which of these insurance plans is best for you, consider your specific needs and affordability. If you aren't too particular about which doctors you use, you may want to go with an HMO. If you have a family and aren't particular about any specific doctor and have frequent doctor's visits, you may also choose to go with an HMO due to the low cost of the premium and co-pays. If you are young, single and relatively healthy, you may prefer a PPO.

Regardless of which of the major medical insurance plans you pick, make sure you have a thorough understanding of coverage as this will protect you from having to pay for unexpected medical bills. At Aegis, our specialized agents will guide you through a needs analysis and match them to a plan that falls within your budget. Contact us today for a free consultation.