Pennsylvania Health Insurance

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There are many types of Pennsylvania health insurance on the market today. HMO, PPO, traditional insurance, Medicare supplement, Medigap, and long-term care are all possibilities depending on your age and your needs.

Pennsylvania Health Insurance

Pennsylvania Health Insurance
HMO (Health Maintenance Organization) is generally the most affordable, but with more constraints than other plans:

  • With few exceptions, any hospital or doctor you visit must be a member of the HMO network.
  • Either you are assigned a primary care physician or you can choose one.
  • Referrals are required from your primary care physician when you see a specialist.
  • Prior authorization is required for most treatments beyond what your primary care physician provides.

PPO (Preferred Provider Organization) offers more options than the HMO:

  • You may visit any doctors (preferred providers) within the PPO health insurance network.
  • By checking a PPO list of doctors before you sign up, you can determine whether doctors you want are participants.
  • No referrals are needed and no prior authorization within the network.
  • Costs are generally lower within the network.

Traditional Pennsylvania health insurance is also known as fee-for-service or indemnity insurance:

  • You pay for service and then you are reimbursed when the insurance company pays the claim.
  • The advantage is you may choose any doctor you desire.
  • The disadvantage is you may not be reimbursed for all of your out-of-pocket expense.
  • There can be a several month delay in getting your payment from the insurance company.

Medicare Supplement and Medigap Pennsylvania health insurance plans cover what the Federal Medicare plan does not cover:

  • Medicare is available to everyone over 65 and to those with disabilities under age 65.
  • Medicare Part A covers hospital expenses and is free.
  • Medicare Part B covers doctors office visits,laboratory tests and x-rays. You pay for this plan.
  • Medicare Part C (Medicare Advantage Plan) is much like an HMO. Medicare contracts with private insurance companies to cover both Medicare Part A and Part B. These plans are usually less expensive than the combined cost of Part A, Part B, and a Medicare Supplement. They may include extras like vision or dental care.
  • Medicare Part D is a prescription drug plan. You must sign up even if you are not taking any prescription drugs. Every year there is a window of time when you can sign up for the plan that provides the best coverage for the drugs you are taking at the lowest cost to you.
  • Medigap or Medicare Supplement plans fill in the gaps where coverage is lacking in Medicare Part A and Part B. There are many plans to choose from with varying costs. Your health insurance advisor will help you decide. With Part C, it is not necessary to purchase Medigap insurance.

Long-Term Care insurance is Pennsylvania health insurance you purchase long before you need it, while you are still in good health:

  • It covers care in a nursing home or assisted living facility.
  • It may cover care in your own home.
  • It is designed to provide for what Medicare Part A and Part B or what other insurances do not cover.

Pennsylvania Health Insurance

If you are under the age of 65, you may choose a traditional plan, or a plan with a network of preferred providers, such as an HMO or PPO. Quite often you will find your favorite physicians in the network you are considering. If you absolutely must visit a favorite doctor that is not on any PPO or HMO, traditional PA health insurance may be your only option.

It is important to remember that most offices will not bill for this type of insurance without up front payment. Also, it may take months to receive your reimbursement. It is not uncommon for these types of plans to pay only a portion of the bill, as well. If you cannot wait for repayment, a traditional plan may not be for you.

If you are over age 65, Medicare Part A is free. Part B is optional and you pay for it. Some confusion comes if you are working over age 65 and participate in a group plan. The rule is that if you are still working, your group insurance is the primary payor and Medicare is second. This means that your group insurance gets billed first and then Medicare is billed. If you are retired and still participate in your company’s group plan, Medicare is billed first and then your group.

As you plan for the future, if you are under age 65, long-Term Care insurance is worth considering. The premiums are very low when you are younger and if you develop health problems later you probably won’t qualify for coverage.

As you can see, it is important to think about your individual needs as you consider the many Pennsylvania health insurance plans available today. Do some research, talk with professionals and take your time as you make these vital decisions.

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