Health Insurance

Health insurance for you and your family is critical, and many times employers will pay for at least a portion of your health-insurance coverage. Although you'll still pay for part of the premium, the cost is usually much less than if you had to pay for health insurance yourself.

Note: If you currently qualify for Medicaid benefits, getting a job could change your benefits. However, there are special rules, called work incentives, which make it possible to work and still receive some benefits. To learn more, go to the Medicaid Web site and look for information about the "Ticket to Work" program.

There are many types of health care plans available. The major categories include the health maintenance organization, preferred provider organization, indemnity plan, and point-of-service plan.

Health Maintenance Organization
In a health maintenance organization (HMO), usually you must use the doctors, hospitals, and pharmacies included in the HMO. You choose a "primary care physician." When you get sick, you usually will see your primary care physician first. He or she will then send you to other doctors in the HMO if you need to see them. If you visit a doctor who is not part of the HMO, you must pay those costs. A few HMOs permit you to use a non-HMO provider and have part of the cost covered, but make sure you know what your plan will do.

One benefit of an HMO is that you pay only a small amount (usually from $5 to $25) for each doctor’s visit or prescription. The HMO pays the other costs. HMOs try to prevent an illness, not just cure it. They often will pay for things such as physical exams, children’s immunization shots, flu shots, and mammograms.

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Preferred Provider Organization
A preferred provider organization (PPO) has many doctors and hospitals in its network. You can use any of them that you like. You usually can use a doctor who is not in the PPO network, but you will pay more if you do. PPO plans usually pay for care to prevent illness.

As long as you go to your primary care physician or another PPO doctor, you will pay only a small fee for each doctor’s visit (usually in the $10 to $25 range). This fee is called a "copayment" or "copay." You also may have to pay a yearly "deductible." The deductible is paid out of your own pocket. After you have paid the deductible (if you have one), the medical plan will pay its share or percentage of your covered medical expenses.

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Indemnity Plan
With this type of plan, you might pay for a doctor’s visit out of your own pocket and then the indemnity plan pays you back. Or, the doctor sends a bill to the insurance company. Then, after the insurance pays, the doctor bills you directly for any unpaid amount. In an indemnity plan, you can go to any doctor you choose.

Indemnity plans usually pay you back only when you are sick or hurt. They usually do not pay for health care that keeps you from getting sick.

You will pay part of the costs out of your own pocket. Indemnity plans usually repay you $8 for every $10 that you spend. Also, you will have to pay a deductible before the plan begins to pay. That amount can be anywhere from $100 to $1,000 or more.

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Point-of-Service Plan
A point-of-service (POS) plan looks a little like an HMO, a little like a PPO, and a little like an indemnity plan. If you use the HMO-type medical care, it costs you the least. It costs a little more if you use the PPO caregivers. It costs the most if you use doctors who are not part of the plan. You get to choose, but your choice will affect how much it costs you. This plan usually pays for care to prevent illness.

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