Short term health insurance coverage is designed for the family or individual who needs coverage for a period of time not less than 1 month and not more than 3 years. If the insured does not fall into this category, a long term plan may provide more effective coverage for one’s needs. Short term health care is purchased individually rather than being provided through an employer or company but provides the same basic coverage. The main difference is the premium costs. Premiums for short term coverage are typically higher simply because the individual bears the full financial responsibility for the premiums with no offset by a third party.
In Florida and most other states there are three major types of managed care plans. They are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans. Managed care plans typically provide a full range of health services to their members, and offer monetary or financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying independently for each service you receive, your coverage is paid in advance. This is called prepaid care.
For example, you might decide to join a local HMO where you pay a monthly or quarterly premium. That premium remains the same whether or not you use the plan’s services. Most plans charge a co-payment for some defined services. For example: $15 for an office visit, or $10 for every prescription. So, if you decide to join this HMO, you might find you have a few out of pocket expenses for medical services, as long as you use hospitals or doctors participating in or are part of the HMO. Your share will be only the small co-payments; typically, you will not have coinsurance or deductibles.
One of the alluring features of HMOs is that they deliver care directly to patients. Patients sometimes go to a medical facility to see doctors and nurses or to a specific doctor’s office. Another archetypical model is a network of individual practitioners. With these individual practice associations (IPAs), you will get your care in a doctor’s office.
If you are a member of an HMO, generally you must receive your medical care through the plan. Typically, you will select a primary care physician who facilitates care. Primary care physicians may be private family practice doctors, pediatricians, internists, or many other medical care specialists. The primary care physician is responsible for referrals to specialists when needed. While most of these specialists will be “participating providers” in the HMO, there are cases in which patients who are members of an HMO may be referred to providers not in the HMO network and can still receive coverage.
PPOs and POS plans are also categorized as managed care plans. Many people the POS plan “an HMO having a point of service option.” From the member’s viewpoint, these plans compound features of fee for service and HMOs. They are more flexible than HMOs, but premiums are generally somewhat higher.
With a PPO or a POS plan, you will get some reimbursement if you receive a covered service from a provider who is not in the plan. Of course, choosing a provider out of the plan’s network will cost more than a provider in the network. These plans act like fee for service plans and charge you for coinsurance when you go out of the network.
What is the difference between a POS and a PPO plan? A POS plan will have primary care physicians who facilitate patient care; and in most cases, PPO plans don’t. There are however exceptions!
HMOs and PPOs have contracts with hospitals, doctors, and other providers. The insurance companies have negotiated fees with these providers and as long as you get your care from these providers, they typically will not ask you for additional payment. Of course, if your plan stipulates a co-payment at the time of care, you will have to pay that.
What is covered under Short Term Health Insurance in Florida? Depending upon the type of policy chosen by the individual the same basic coverage will apply as under a long term policy or employer provided policy. To list a few: Inpatient hospital services, outpatient surgery, physician visits (in the hospital), office visits, skilled nursing care, medical tests and X-rays, prescription drugs, mental health care, drug and alcohol abuse treatment, home health care visits, rehabilitation facility care, physical therapy, speech therapy, hospice care, maternity care, chiropractic treatment, preventive care and checkups, as well as well-baby care.
Always look closely at the description of all plans you are considering for the terms of payment. Check with your human resources manager, employer, or your Florida’s state department of insurance to find any laws governing who is responsible for payment of insurance premiums and above all, make sure you are getting what you pay for. Know what coverage you need and what services are covered under your chosen plan in order to make sure you are purchasing only what you need for this short period of time.