Single Mom’s Guide to Health Insurance

What are the best plans for a single moms guide to health insurance? Having trouble deciphering all the lingo? You barely have time for a shower – no reason to waste a single second translating jargon in order to understand what you’re being offered! Good news! I did it for you.

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If you’re having a hard time picking a single moms health insurance plan, the best way to speed up the process is to know the difference between each one.

Single Moms Guide to Health Insurance Plan 101

Fee-For-Service vs. Managed Care

Health plans fall into either of these categories – some share characteristics of both.

  • Fee-for-service (also known as indemnity) plans are just that. You pay as you go and are reimbursed for covered expenses as they kick in.
  • Managed care plans are prepaid plans. You pay a monthly premium for care within a system of providers.

Rule of thumb: The more managed your health care is, the cheaper. The more independence you have in choosing your doctors and services, the more expensive the plan will be.

Health Maintenance Organization (HMO)

The Classic Managed Care Plan.

If saving money, skipping the extra math and not having to keep track of receipts and claim forms is a priority over getting to pick a particular doctor – this may just be the plan for you.

Bottom Line:

  • You pay a monthly premium, pick a doctor from the list they give you and go through him or her for referrals to specialists.
  • Most of the time there are no deductibles (that’s when you have to fork over a certain amount of cash before insurance starts paying for anything)
  • You pay co-payments for services. For example $20 for a regular doctor’s visit.

Pro’s:

  • Total costs usually cheaper than PPO or Fee-for-service plans.
  • You get a wide range of services.
  • Mostly paperless -- just show an insurance card at appointments.

Con’s:

  • You gotta stick to their list of of doctors, hospitals, and prescriptions
  • Your primary care doctor has to pre-approve any visits to specialists
  • The huge amount of patients limited to this specific list of “in-network” doctors could mean it takes longer to get an appointment.

Preferred Provider Organizations (PPO)

A blend of managed care and fee-for-service. If you can’t handle the restrictions of an HMO and can afford a little more out-of-pocket expense then you may consider this plan a better choice.

Bottom Line:

  • Like an HMO, you pick a primary care physician (PCP) and get a list of doctors that are “preferred.”
  • A higher premium buys you the option to skip referrals from your PCP and go outside the plan’s list of providers.
  • If you stick to their list, you will we working mostly paperless and just paying copays
  • Stepping out of the list involves paying deductibles and sharing the cost of services where the insurance company pays a percentage and you pay the other (this is what the 80/20 in-network or 60/40 out of network mumbo jumbo is all about).

Pro’s

  • You can keep the same doctors or explore different ones without worrying about them being on the list.
  • Get appointments quicker and have services performed faster.
  • Freedom to see a doctor wherever, whenever and still have some coverage.

Con’s

  • Options come with a price
  • More expensive than HMO’s, even if you remain within the “preferred provider” list
  • Paperwork and receipts to keep track of if you step outside the list
  • High deductibles

Point-Of-Service (POS)

POS is not exactly a plan of its own, but more of an option among HMO plans. It’s a bit of the best of both worlds, allowing you the savings and ease of an HMO with more flexible options like a PPO.

Bottom Line:

  • You decide each time you need medical care whether you want to use your plan as an HMO or a PPO.
  • You choose a primary care physician who controls all aspects of care, including referrals to specialists – but unlike traditional HMO, your doctor can refer you to a specialist that’s not on the list.
  • If you go see a doctor or specialist outside the list, you are still covered for a portion of the cost, paying either a significant co-payment or deductible.

Pro’s

  • More choice of doctors and other providers than a traditional HMO
  • The savings and simplicity of a traditional HMO with added flexibility
  • Some may not require you to have a primary care physician

Con’s

  • Higher premiums than traditional HMO plan.
  • Seeing a doctor outside the list will cost you more.
  • More paperwork than a traditional HMO

Major Medical

Major medical lets you see any licensed health care professional for anything covered by the insurance.

Bottom Line:

  • Your premium varies according to the amount of the deductible and the amount of cost you share with the insurance company once that deductible is paid.
  • After you’ve met your deductible, you begin sharing the cost with the insurance company (for example, with an 85/15 provision you pay 15% of the charges and they pay 85%)
  • 15% of a couple days in the hospital can still be enough to bankrupt you, so there are co-insurance maximums apply to protect you from those kinds of bills

Pro’s

  • Offer the most flexibility

Con’s

  • Biggest out of pocket expense.
  • May not cover preventative care.
  • Involves lots of paperwork and receipts.
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