By Irina

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Let's face it - an apple a day is no longer an adequate substitute for professional healthcare services. And after doctor leaves, someone has to reach for a wallet. Accept this undeniable fact of life and make necessary arrangements BEFORE you get into a car accident, suffer intolerable toothache, or become pregnant.

The cold reality of healthcare in this country is that you do not have any legal right to it. There are no state or federal laws mandating employer-paid or -subsidized health benefits. So if you (or your spouse) have a complete and reasonably priced health coverage through your employer - BE GRATEFUL... and find some better use for your time than reading this article. (I would still suggest saving it - just in case...)

For those who keep on reading, health insurance is available on an individual or group basis, but don't be fooled by terms! INDIVIDUAL insurance usually covers A GROUP of people (entire family), and many GROUP health plans will cover "a group" of ONE. In both cases you are only one paying (individually!) for coverage. So, what's difference? From a consumer's point of view, big advantage of group health insurance plans over individual is that they can't turn you down because of health problems.

Of course, ABILITY to get into a health insurance plan is one thing. The AFFORDABILITY is quite another! Let's begin with some basic terminology (or should we call it deceptive lingo?) used in health insurance industry. Here are major plans with unique features to consider while making your choice:

HMO - Health Maintenance Organizations ============================================= The least expensive, but also least flexible of all health insurance plans. Advantage: - Low co-payments, minimal paperwork, and coverage for some preventive-care and health-improvement programs. Disadvantages: - You must choose a primary care physician, also known as a PCP. - HMO requires that you see only network doctors, or they won't pay. - You must get a referral from your PCP to see a specialist.

POS - Point Of Service plans ============================================= More flexible than HMOs, but they also require you to select a PCP. Advantages: - You may visit a doctor outside network and still receive coverage; but substantially less than if you stayed within your network. - Offer more preventive care and well-being services, such as workshops on smoking cessation and discounts to health clubs. Disadvantages: - You must choose a PCP. - If you don't receive permission from your PCP, you're likely to wind up submitting bills yourself and receiving only a nominal reimbursement - if any.

PPO - Preferred Provider Organizations ============================================= Give policyholders a financial incentive - reasonable co- payments (also called co-pays) - to stay within group's network of practitioners. Advantages: - The standard co-payment is $10 for a routine office visit during regular hours. - You may go to any specialist without permission, as long as doctor participates in network. Disadvantages: - If you see an out-of-network doctor, you may have to pay entire bill yourself, then submit it for reimbursement. - You may have to pay a deductible if you choose to go outside network, or pay difference between what network doctors charge vs. out-of-network doctor's charge.

Health Insurance: The-More-The-Better, Or No-More-HMO?

By Irina

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In movie "John Q," Academy award winner Denzel Washington fights HMO restrictions to provide necessary cure for his dying son. When such a lackluster topic like health insurance generates enough drama for a Hollywood movie, you know that something must be seriously wrong...

The problem indeed is severe. Almost 45 million Americans are uninsured and number continues to rise. Those still insured are frustrated by double-digit premium increases outpacing all other sectors of economy. High costs and HMO limitations discourage seeking an immediate medical help. As a result, "little aches" often develop into life-threatening illnesses and financial disasters for some unfortunate individuals and further escalate already intolerably high health care costs for rest of us.

To endure existing health care crisis, we all must recognize one simple fact. There are TWO DIFFERENT LEVELS of health care needs that must be covered with two separate tiers of payment. One level is catastrophic illness - and for that, insurance may still be answer. Policies that carry a high deductible (say $5,000 a year) are relatively inexpensive, even when coverage is very high ($1 million or more) or unlimited. That is because most people do not get catastrophic illnesses or injuries.