Published May 28th, 2015 by Stephanie
At USA Rx, we find that both employers and individuals often have difficulty in understanding the scope and restrictions of any given insurance plan. This confusion has been further compounded through expanded options for compliance with health insurance mandates, but also through actual cost comparisons of the benefits of different plans.
Although many of the insurance options seem to offer comparable quality over a range of prices for both the employer and the individual, the differences between plans can make a large difference in how effective they really are for meeting needs.
While Health Management Organizations (HMOs) can vary, they also tend to have a larger in-network group for care services. HMOs in general can be seen as an umbrella coverage for treatment and preventive care, although the cost benefit to employees only applies for providers who are recognized by the HMO, and some emergency situations. This also means that specialty care would become an out-of pocket cost for individuals, although this is also part of the reason these plans have lower premiums and deductibles.
Prescription coverage with HMOs can vary greatly, especially since this plan allows individuals to select tier based plans. Different levels of plans can include greater inclusions for pharmaceuticals, with set co-pays on many common drugs, although depending on the provider, there may also be caps on what can be claimed over the course of a year.
Preferred Provider Organizations (PPOs) may also be present through insurance providers who use HMOs as well, but this type of coverage can also require greater management. For that reason, the initial cost for employers can vary greatly, depending upon the insurance provider. However, this also means that PPOs tend to give greater support to both companies and the individuals, based on the agreement for service that has been negotiated.
People are also able to retain medical attention outside of the network without a referral, and can have the option to independently submit for partial reimbursement. The result is that PPOs can have a greater applicability for diverse populations, where health needs are more varied, and tend to have greater inclusions for prescriptions. However, these plans also tend to cost more initially, and have higher deductibles, which can add up, especially when out of pocket prescriptions are figured into the equation.
Health Reimbursement and Health Savings Accounts (HRAs and HSAs) have become a popular form of insurance for many small businesses and even self-employed individuals. These plans are not network based in the same way as PPOs and HMOs, but can allow employees or individuals to utilize the funds as health concerns arise. Essentially, employers and individuals contribute to the account, and this money is then used to pay for health care needs.
While HRAs and HSAs are presenting a very cost effective means of attending to wellness, especially with direct care, these accounts do not actually reduce the cost of medications the way some HMO and PPO plans will. However, the inclusion of a pharmacy discount card is one way that employers and individuals can expand the applicability of this approach.
Regardless of the type of plan that a person has, prescription costs are still one of the gaps that remains common for wellness concerns. The USA Rx pharmacy discount card is frequently used with HRAs and HSAs, and under some conditions of other insurance plans, as this extends the adjunct savings that can allow for better use of the health care funds.
If the cost of prescriptions is a concerns for your wellness needs, then we encourage you to sign up for the USA Rx pharmacy discount card today, and provide yourself, or your employees, with a better way to manage health and costs.