Understanding Health Insurance in O’Fallon, MO

Understanding the basics of health insurance is crucial for making informed decisions about your healthcare coverage. Buchmann Benefits, based in O’Fallon, MO, provides small businesses with options regarding Health Insurance plans. Let’s take a look at some things to understand, then give us a call at (314)931-6448, to discuss a detailed plan that works for you and your employees.

Types of Health Insurance Plans:

• Health Maintenance Organization (HMO): Requires you to choose a primary care physician (PCP) and typically limits coverage to care from doctors who work for or contract with the HMO.
• Preferred Provider Organization (PPO): Offers more flexibility in choosing healthcare providers, both in-network and out-of-network, without requiring referrals to see specialists.
• Exclusive Provider Organization (EPO): Similar to PPOs but usually does not cover any out-of-network care except in emergencies.
• Point of Service (POS): Combines features of HMOs and PPOs, requiring you to choose a primary care doctor and providing coverage for both in-network and out-of-network care.

Key Terminology:

• Premium: The amount you pay for your insurance plan, usually monthly.
• Deductible: The amount you must pay out of pocket for healthcare services before your insurance plan starts to pay.
• Copayment (Copay): A fixed amount you pay for covered healthcare services after you've paid your deductible.
• Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage (e.g., 20% coinsurance means you pay 20% of the cost, and the insurance pays the rest).

Coverage and Benefits:

• Preventive Care: Services like vaccinations and screenings that are often covered without cost sharing.
• Emergency Services: Coverage for emergency room visits.
• Prescription Drugs: Coverage for medications prescribed by your doctor.
• Mental Health Services: Coverage for counseling and therapy.
• Maternity and Newborn Care: Coverage for prenatal care and childbirth.

Networks:

• In-Network: Healthcare providers and facilities that have contracted with your insurance company to provide services at negotiated rates.
• Out-of-Network: Healthcare providers and facilities that do not have agreements with your insurance company, which may result in higher out-of-pocket costs.

Enrollment and Eligibility:

• Typically, you can enroll in or change health insurance plans during the annual Open Enrollment Period or if you experience a qualifying life event (e.g., marriage, birth of a child, loss of other coverage).

Understanding Costs:

• Besides premiums, deductibles, copays, and coinsurance, consider out-of-pocket maximums, which limit how much you have to pay for covered services in a plan year.

Additional Considerations:

• Flexibility: How much choice do you need in selecting healthcare providers?
• Affordability: Balance premiums with potential out-of-pocket costs.
• Coverage Needs: Consider your health status, any ongoing treatments, and the needs of family members covered under the plan

When discussing health insurance with Buchmann Benefits, they can provide personalized advice based on your specific needs, the plans available in O’Fallon, MO. They can also guide you through the enrollment process and help you understand the details of each plan's coverage and benefits. Give them a call today at (314)931-6448.