North Carolina Insurance: Health Insurance How-To’s

Health insurance is an industry with a vast variety of options, meaning it’s impossible to pinpoint the exact best one. Instead, health insurance policies should be purchased according to each individual and their special circumstances. However, although the final decision on which type of policy is best for you and your family is ultimately yours, there are some easy and smart guidelines to help direct you in your selection. By learning the basics of North Carolina insurance health plans, you will be better informed in your decision and in the end save the most money and choose the ideal coverage for you. 

Health Maintenance Organization (HMO)
     o What Is It: A network of doctors in which an individual chooses a primary care physician (PCP) and receives referrals to specialists when needed.
     o Pros: If you like the doctors within the HMO network, then this is cheap and simple type of policy. There are no deductibles and most basic procedures (check-ups, physicals, etc.) are 100% covered after an inexpensive co-payment.
    o Cons: If a specific doctor you want to see isn’t within the HMO doctor, then you must cover all costs of the visit. Also, because of the need for referrals from your PCP, having an HMO might cause a delay in receiving the medical care you need.
 • Preferred Provider Organization (PPO)
    o What Is It: Similar to an HMO, this plan has a network of doctors that your insurer has negotiated a specific rate with. However, it differs in that a PCP is not required for referrals and therefore you are able to schedule appointments with any doctor.
    o Pros: With a PPO, you have the option to use any doctor even if they are out-of-network and still receive some sort of coverage (commonly PPO’s cover 70% of out-of-network doctor visits).  Therefore, this plan offers the widest array of doctors.
    o Cons: The widest selection of doctors comes at a cost, as PPO’s often have the highest premium costs for all insurance plans.

Other important terms to know:

 • COBRA (Consolidated Omnibus Budget Reconciliation Act) – A government that allows people to continue using their previous employer’s health plan for up 18 months after leaving their job or getting laid off. While individuals have to pay the full price for the premium (rather than the 20-30% that wasn’t covered by their employer originally), this can be better than having no insurance at all.        

Health Savings Account (HSA) – With an HSA, the money you use to pay your deductible comes from an account funded from your pre-tax dollars. The money comes from your pre-tax paycheck and any balance at the end of the year carries over to the next year. The stipulation is that you can only withdraw money from this account for health-related expenses. 
 • Flexible Savings Account (FSA) – This is a supplement account you can have to your HMO or PPO plans to cover deductibles, co-pays, and other health expenses. Similar to an HSA it comes from your pre-tax dollars, but the difference is any money not used by the end of the year is lost or forfeited.

Still want to know more on health insurance and other forms of North Carolina insurance? Call Spivey Insurance Group today at 877-318-5951 or visit our useful website which is loaded with tips and information and offers free NC insurance quotes.

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