Individual and Family Health Insurance
Here at the Capistrano Health Insurance, we know that you face a dizzying array of health insurance options. It is possible-and even easy-to spend tens of hours researching health insurance options and still not know if your have found the best health insurance option for you and your family. Even worse, you may suffer from "paralysis by analysis," putting off choosing a plan because you are overwhelmed by the options.
Get an Induvidual or Family Health Insurance Quote!
That's where the experts at Capistrano Health Insurance come in.
We start by learning your individual or family health insurance needs. Once we know your priorities and budget, we do the research for you, narrowing your health insurance choices down to a simple few that maximize your health insurance dollar. We simplify the complex and make it easy to understand so you can make an informed health insurance decision and get on the kind of active lifestyle enjoyed by residents of the San Juan Capistrano and other Beach Cities of Orange County.
HMO, PPO, POS, HSA-Capistrano Health Insurance boils the alphabet soup of health insurance solutions down to an easy-to-understand menu of choices.
PPO Simplified
PPO is an acronym for three different phrases: Preferred Provider Option, Preferred Provider Organization, or Participating Provider Organization. All three terms describe the same thing: a network of healthcare providers bound together by a contract with a health insurance company to ensure quality healthcare with reduced health insurance costs. The network includes medical doctors, nurses, lab technicians, hospitals, and other healthcare providers such as diagnostic laboratories. Most PPOs cover preventive care, including physicals, well-baby care, immunizations, and mammograms.
With a PPO healthcare plan, you save money by using doctors and healthcare facilities within your PPO network. However, you also can use doctors who are not part of the plan and still receive some coverage. When you use "out of network" services, you pay a larger portion of the bill yourself. The ability to use out-of-network services can be especially valuable when a family already has one or more doctors outside the network. For example, a family might have a general physician in the network while a pediatrician or gynecologist is outside the network. The family members can stay with their doctors and still receive coverage.
When you and choose a PPO health insurance plan for yourself and your family, your share of health insurance costs includes your:
Deductible
The deductible is an amount of money you must pay out of pocket before the insurer will cover any expenses. Calculated on an annual basis, the deductible varies depending on the size of your family and other factors.
Coinsurance
Even after you have met your deductible amount, your insurer will not pay 100% of the remaining costs. You are responsible for an additional amount of the cost of the medical services or treatment. This additional amount is known as coinsurance. Sometimes the coinsurance is a fixed amount, but more often it is a percentage of the remaining costs.
HMO Simplified
HMO stands for Health Maintenance Organization. Like a PPO, an HMO controls costs by managing care through a network of healthcare providers. With an HMO, care is paid for only when you receive services from doctors and other medical healthcare professionals who are part of the network. In addition, your care is managed by your Primary Care Physician, the doctor you see for routine visits. To see other doctors within the HMO, you must receive a referral from your primary care physician.
The main benefit of an HMO is cost savings. Most HMO members pay a fixed fee and receive access to the full range of medical services, including diagnostic and treatment services, hospitalization, surgery, and prescription medication. HMOs also offer additional medical services, such as vision, dental, and psychiatric care. In addition to the fixed fee, HMO members also pay set amounts, known as co-payments, for doctor visits.
Prescription Drug Coverage
Both PPO and HMO plans offer prescription drug coverage. Some plans cover both name brand and generic drugs. Other plan cover only the generic drugs (when they are available). Some plans do not cover drugs at all. The costs of prescription medication can be staggering, so Capistrano Health Insurance takes into account the amount of prescription drugs your family uses when researching the best plans for you.
