Health insurance is one of those things we’d rather not think about. But as adults, and especially as parents, we are forced to deal with it. The upcoming election year is sure to bring even more talk of how broken the system is and ideas for dramatic changes. But until the powers that be figure out a better way, we are stuck with what is available and affordable for our families. The following is meant to be a simple explanation of the health insurance options available in California. There are pros and cons to each. You will no doubt want to do more research, but this should give you a good start.

HMOs
HMO stands for “Health Maintenance Organization.” This type of insurance is available only in the United States. An HMO is attractive to many families because it offers cheaper insurance than traditional plans. It does this by contracting with a specific set of providers (doctors and hospitals); in return, they usually agree to provide services at a discount. Secondly, the HMO eliminates treatments it views as unnecessary, and attempts to look after the long-term health of their members, therefore reducing costs. Here are the main features:
• When you join an HMO, you are asked to choose a primary care physician (or PCP). This doctor then acts as the HMO's agent in determining what treatments you (the patient) need or don’t need.
• If your primary care physician determines that you need care they cannot offer, your PCP will refer you to a specialist who can address those concerns. You can’t just make an appointment with a specialist without a referral from your primary care doctor.
• Emergency visits are exempt from this referral process, and in most cases women are able to choose an OB/GYN.
• HMOs typically do not set deductibles that must be met before insurance benefits begin. Instead, HMO members usually pay only a nominal co-payment for care.

PPOs
A PPO, or “Preferred Provider Organization,” allows you to see any doctor you wish, or visit any hospital you choose, usually within a preferred network of providers. The differences here are:
• PPO members do not choose a primary care physician and can refer themselves to specialists. This allows for more choice and flexibility.
• You may choose a doctor or specialist outside of the preferred network, but the insurance will typically cover only 70-80% of the cost.
• PPOs usually require members to meet a deductible (especially for hospitalization) and may have larger co-payments than HMOs.

Concierge Medicine
This “new” form of medical care—really a return to the old style of care—is often called “concierge” or “boutique” medicine. Here a doctor accepts a limited number of patients, usually about 500 (compared to the 2500-3500 that most network doctors see). The doctor provides his or her patients with personalized care in an environment where visits are not rushed, patient’s questions are answered and follow-up is routine:
• Doctors make same day, non-emergency appointments, often make house calls, and are willing to give out an after-hours phone number where they can be reached.
• The annual cost for this type of care is between $1500-2000 per year, which equates to about $60 per month for adults with no co-pays.
• Concierge care does not cover major surgeries or catastrophic care.

HSAs
With the Health Savings Account, the idea is that you purchase a low-cost, high deductible major medical insurance policy that pays for those big medical bills. Then you save money into this 100% tax-deductible HSA account to pay for those big deductibles when they occur.
• The money can be used tax-free for medical expenses, and if it's not used, it rolls over year to year.
• At age 65, the money can be used like a retirement plan, or still saved for future medical expenses.
• Regardless of your deductible, you can save up to $2,850 per year as a single person, or up to $5,650 as a family with this HSA account.
• Keep in mind this is only for “major” medical expenses, not well-baby visits, immunizations, the flu or other routine health care.

So, which is best? Unfortunately, there isn't one right answer. The best choice depends on your family’s particular needs. You will want to evaluate which form of coverage best meets the requirements of your family and your finances.