Fort Myers, Florida Individual Private Insurance

Individual health insurance is coverage that you purchase on your own, on an individual or family basis, as opposed to obtaining through an employer or from a government-run program like Medicare, Medicaid, or CHIP.

Choosing your health insurance is a task that warrants your attention every year. Even if you’re happy with your coverage, it’s still a good idea to review your options to ensure you’re making the best choice for your health and wallet. Here are the two most common types of health insurance plans along with what to consider for each.

HEALTH MAINTENANCE ORGANIZATION (HMO)

With an HMO plan, you are given a list of doctors within a network (who either work directly for the HMO or contract with it) and pick a primary care physician to oversee all your care.

Pros: HMOs are often the most affordable choice because they typically have lower monthly premiums, which is the amount you pay each month for your coverage. Because an HMO often focuses on wellness and preventive care, it can help you maintain a healthier lifestyle.

Cons: Your choices are limited to the network’s list of providers, and your insurer typically won’t pay for a provider who’s outside the network (or it will make you pay a much higher proportion of the cost). Plus, if you need to see a specialist, you’ll most likely need a referral from your primary care physician.

PREFERRED PROVIDER ORGANIZATION (PPO)

For PPO plans, you have a list of pre-approved providers who contract with the plan, rather than providers who work directly for it. While reimbursement percentages vary for seeing someone out of network, a 60/40 split is common, which means the insurer pays 60 percent of the costs and you cover the remaining 40 percent.

Pros: In addition to having a greater choice of doctors, you won’t need to ask for a referral to visit a specialist.

Cons: A PPO will likely cost you more than an HMO, as they typically have higher monthly premiums and copayments. In addition, you often have to pay a deductible (the amount you pay out of pocket before your insurance benefits kick in). So, if you have a $1,000 deductible, this means you will pay the entire $1,000 for any medical services you receive before insurance kicks in.