3 Coverage Considerations for Family Health Insurance

May 7th 2016
Finding top-notch health insurance is a necessity for you and your family, especially when you want your children to grow up safe and healthy and get the medical care they deserve. Whether you have employer-provided medical insurance or you're looking into a plan offered through providers in the Affordable Care Act plan, you need to keep a few considerations in mind when you're shopping for the perfect family health insurance plan. 
Differences Between PPO and HMO
One problem you encounter when shopping for health insurance is the sheer amount of acronyms involved. Two acronyms you see often are PPO and HMO. A PPO, or preferred provider organization, gives you a variety of doctors and specialists to choose from when you need medical attention. You have a specific set of doctors within the network and higher costs associated with out of network doctors and specialists, according to Blue Cross Blue Shield. An HMO, or health maintenance organization, requires that you pick a primary care physician who refers you to specific specialists if needed. You are unable to go directly to a specialist, even if they are within the HMO network, without the PCP sending you there. This helps cut down on medical costs overall, but it may not give you the flexibility you need when you already know that your kid needs to go to a specific specialist.  
Regardless of whether you choose PPO or HMO, you still have co-insurance, monthly premiums and deductibles to deal with. The monthly premium is the amount you pay the insurance company every month to keep your insurance coverage. This gives you access to all of your health benefits, your network doctors and, in the case of an HMO, your primary care physician. The premium is affected by your age, general health, the health of the insurance pool you enter, the deductible, your co-insurance and several other factors. When you have a deductible, that's the amount of out of pocket expenses in addition to co-pays that you pay for medical care. A large deductible lowers the premium cost significantly, but it does end up costing you a significant amount throughout the year before insurance kicks in to cover you. 
Single or Family Plan
A family plan covers all immediate family members, which includes the spouse and all of their dependents. In some situations, the family plan price is significantly higher if a particularly high-risk individual is added into the family plan, as opposed to getting their own individual plan. According to Health Care Plain and Simple, the high-risk member of the family may opt to get a separate plan to keep the average cost of the family plan significantly cheaper. 
The high-risk pool is also a reason to consider breaking away from your employer's health insurance in some cases. Compare your premiums with your employer-provided health insurance versus the health insurance you get on your own. While it won't always be set at a better price, it's worth looking into when you want the best deal possible for your health care. 
What's Included?
Pay extra attention to the specialists included within the network if you have a PPO or within the HMO's coverage area. If you have a preferred specialist or doctor for yourself, your spouse or your children, check that they accept the insurance you sign up for ahead of time. Look through the co-pays and other associated costs for specialist appointments, generic and name brand prescriptions, payments for emergency room visits and other hospital costs and the types of tests covered by insurance. You don't want to fall into a trap of not getting to the doctors you need because you incur out of network fees or have to pay more than expected for prescription medication because the co-pay on medicine is through the roof. 
References:
(1) http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/difference-between-hmo-ppo.html
(2) http://www.healthcareplainandsimple.com/choose-the-right-plan/insuring-your-family.aspx

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