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Senior Health Insurance

For seniors, there are two major types of health plans – fee-for-service plans and managed care plans. Managed care plans are often referred to as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Individual Practice Associations (IPAs), and Point of Service (POS) plans.

Fee-for-service or indemnity plans allow you to use any medical provider. You or the provider sends the bill to the insurance company after services have been rendered. There is a deductible that you must pay each year before the insurers covers their part of the cost. Once you make the deductible payment, the insurer usually pays about eighty percent of what are referred to as "usual and customary" charges while you pay twenty percent, or the coinsurance. These plans pay for charges incurred through medical tests and prescriptions but may not pay for preventative care like checkups.

PPOs have arrangements with various medical providers who agree to charge lower fees from the insurer for services. Because of this, you don't have complete freedom in choosing providers, but you do have lower costs that are passed on to you as long as you stay within the network.

HMOs offer a wide range of health benefits including preventative care for a fixed monthly fee. HMOs provide members with a list of doctors they can choose from. You have to go through a primary care physician before you can go to a specialist. Some HMOs require no copayment. Most charge a minimal fee.

POS plans are like indemnity plans. Here, primary care doctors in a POS plan generally make referrals to other providers. In addition, members can refer themselves out of a plan but still get coverage.

When looking for the right health plan for you, consider the responses to the following types of questions: Does the plan provide preventative services? Does it include the doctors and hospitals I want and need? Does it provide the benefits I need? Are the doctors, pharmacies, and other services available at convenient times and locations? Does the plan fit my budget?

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