For many people, attempting to understand health care can feel like trying to find their way through a maze. All of the confusing the costs, terms, conditions, and stipulations can start to sound like a foreign language. Here, we set the facts straight.

What should I look for when choosing a health plan?

When choosing health insurance for you and your family, it's important to weigh the benefits of each plan. While no plan will pay 100 percent of your medical expenses, some provide more coverage than others. According to the Agency for Healthcare Research and Quality, points to compare include:

  • Premiums
  • Coverage/benefits
  • Access to doctors, hospitals, and other providers
  • Access to after-hours and emergency care.
  • Out-of-pocket costs (co-insurance, co-pays, and deductibles).
  • Exclusions and limitations.

What's the difference between an HMO and a PPO?

An HMO (health maintenance organization) is a type of health-care coverage that generally requires that the patient choose a primary care physician from a list of doctors within the HMO network who can provide a referral to approved specialists. As a result, the HMO usually will not, without prior approval, cover medical expenses incurred by seeing someone who is not contracted with the HMO. Exceptions exist for emergency medical care, which does not require prior authorization and, in some cases, for women to select an ob-gyn without a referral.

In contrast to an HMO, a PPO (preferred provider organization or participating provider organization) offers more flexibility. Although a PPO also has a network of contracted physicians, generally it allows a patient to see any doctor they wish. Patients who chose to see physicians who are not a part of a PPO can do so by paying a higher deductible. The patient doesn't have to designate a primary care physician, and he or she can usually see any specialist without a referral. But although a PPO offers more choices and flexibility, it's often more expensive.

I've heard the term COBRA. What exactly does it mean?

COBRA, which stands for Consolidated Omnibus Budget Reconciliation Act, is a law that was passed by Congress in 1986. Under certain circumstances, this law allows former employees, retirees, spouses, and their children the right to temporarily continue their health coverage at group rates. Even though this coverage is usually more expensive than health coverage for active employees (since the employer often pays for a portion of the amount), it's still less expensive than seeking out individual health coverage. Medical benefits provided under the terms of the plan and available to COBRA beneficiaries may include:

  • Inpatient and outpatient hospital care.
  • Physician care
  • Surgery and other major medical benefits
  • Prescription drugs
  • Any other medical benefits, such as dental and vision care

What is Medicare Part D? Is it the same as Medicare?

Medicare is a health insurance program for people ages 65 and older and some individuals with other health conditions. It currently covers nearly 40 million Americans, according to the Department of Health and Human Services, making it the nation's largest health insurance program.

Medicare Part D, on the other hand, is a federal program designed to help pay for prescription drugs for Medicare recipients. This benefit, added to Medicare by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, began in early 2006. Unlike coverage in other parts of the Medicare program, patients must actively enroll in one of many hundreds of Part D plans offered by private companies. Each year from November 15th to December 31st, people with Medicare can either enroll in a plan or change their current one. All plans will have different costs and benefits, so it's important to consider your prescriptions and needs when making a decision about the coming year.

Are there certain procedures that not commonly covered by insurance?

Some procedures are considered elective, or not medically necessary, and therefore may not be covered by your health plan. Examples of procedures that are not usually covered include:

  • Dental: Tooth whitening, veneers, and implants.
  • Cosmetic Surgery: Elective procedures such as hair restoration, breast augmentation, scar removal, and liposuction.
  • Vision: LASIK surgery and other vision-correction procedures.
  • Orthodontics: Braces or bite-correction procedures.
  • Fertility: Visits to fertility clinics as well as treatments to become pregnant.

However, other options are available. Health-care financing companies, such as Capital One, offer low-interest loans to help consumers who qualify pay for these types of procedures.