Health Insurance Terms and FAQ:

Preferred Provider Organization (PPO): The main concept behind a PPO is the network. If you opt for this type of insurance, you may choose any health care provider from within your network, determined by your policy, or any non-network health care provider. You are usually required to make a co-payment or pay co-insurance. Staying in-network saves you a bundle with the PPO!

Health Maintenance Organization (HMO): Like the PPO, the HMO requires you to make a co-payment to an in-network physician. However, an HMO will not pay for services you receive outside the network. Your primary care physician acts as the gatekeeper to your health care. In order to obtain specialty care, you must attain a referral from them.

Out-of-pocket limit:  After you spend a certain amount on covered medical services, including your co-payments and deductibles, your insurance company pays the rest of your medical expenses for the remainder of the year.

Lifetime Maximum:  Your plan only pays a certain amount for medical care you receive throughout your lifetime. This amount varies depending on your plan. This is especially important to know if you or a family member suffers from an ongoing medical condition.

Exclusions and Limitations:  Depending on your policy, some services are not included, like cosmetic dentistry or mental health care. And some items are limited, such as the length of time you can stay in the hospital. You are responsible for those things excluded or limited by your plan.

Rate Increases. Do they increase as I get older?  As you age, you're at higher risk for certain health conditions. For example, men are more susceptible to prostate cancer after age 55. Insurance underwriters take those types of statistics into account. Asking questions and understanding how they determine your health ranking is the best way to ensure you get a fair price. Conditions like high cholesterol or blood pressure used to guarantee a higher insurance rate. But because of medical advances, that is no longer the case.