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As the Trump Administration crafts the replacement legislation for the Affordable Care Act, the under 65 medical insurance market remains in a " wait and see" mode - The American Seniors Association is watching very closely and will advise our members as developments arise. In the mean time, individuals under 65 years of age still need protection against illness and injury - either of which can interrupt your plans - but they don't need to deplete your savings or jeopardize all that you've worked for.
There is no fee to call and ask questions. You are under no obligation to purchase a plan or pay any fees nor will anyone pressure you to do so.
A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether you receive your care in or out of the health insurance company's network of providers. Like an HMO plan, you may be required to designate a primary care physician who will then make referrals to network specialists when needed. Like a PPO plan, you may receive care from non-network providers but with greater out-of-pocket costs. You may also be responsible for co-payments, coinsurance and an annual deductible.
PPO plans give you flexibility. You don’t need a primary care physician. You can go to any healthcare professional you want without a referral—inside or outside of your network. Staying inside your network means smaller copays and full coverage. If you choose to go outside your network, you'll have higher out-of-pocket costs, and not all services may be covered.
PPO plans do not require you to choose a Primary Care Physician (PCP) and do not require referrals. A PPO plan would allow you to continue your visits regardless of whether your doctor or specialist is in- or out-of-network and without a referral from a PCP. It is important to remember, that while you can receive care from any doctor, specialist or hospital you choose, you will save more money by choosing an in-network provider.
HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP.
With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than with other types of plans. If you are someone who doesn't see a lot of specialists or would like having your care coordinated through a PCP, then you might save more money with an HMO plan. When you apply for an HMO plan, you'll select a Primary Care Physician who will be the first point of contact for your healthcare.
Your PCP will be able to see the total picture of your overall health. Together you can make the best decisions to manage your health and well-being, which includes your PCP making referrals to specialists. If you have a standing relationship with a doctor or specialist outside of your network, or would prefer more flexibility when choosing your care providers, you might consider a Preferred Provider Organization (PPO) plan instead. PPO plans often feature a higher monthly premium and out-of-pocket medical costs but will allow you the freedom to choose doctors and specialists that are in- or out-of-network without a referral from a PCP.
A health savings account (HSA) combines high deductible health insurance with a tax-favored savings account. Money in the savings account can help pay the deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep.