Understanding Your Health Insurance Plan
Beginner English listening exercise · Health Insurance
Transcript
[HR Rep] Welcome aboard, Lisa. Let's go over your health insurance options. We offer two plans — an HMO and a PPO. [Employee] I've heard those terms but I'm not sure what the difference is. [HR Rep] Great question. An HMO, or Health Maintenance Organisation, requires you to choose a primary care physician who coordinates all your care. You need a referral to see a specialist. [Employee] And the PPO? [HR Rep] A PPO, or Preferred Provider Organisation, gives you more flexibility. You can see any doctor without a referral, but you'll pay less if you stay within the network. [Employee] What's a network exactly? [HR Rep] It's a group of doctors, hospitals, and other healthcare providers that have contracted with the insurance company to provide services at discounted rates. [Employee] Which plan is cheaper? [HR Rep] The HMO has lower monthly premiums — two hundred dollars per month versus three hundred for the PPO. But the PPO has more flexibility. [Employee] What about the deductible? [HR Rep] The HMO has no deductible for in-network services. The PPO has a one-thousand-dollar annual deductible, meaning you pay the first thousand dollars of care before insurance starts covering costs. [Employee] What's a copay versus coinsurance? [HR Rep] A copay is a fixed amount — like thirty dollars for a doctor visit. Coinsurance is a percentage — like twenty percent of the total bill. After you meet your deductible with the PPO, you pay twenty percent coinsurance until you hit the out-of-pocket maximum of five thousand dollars. [Employee] I think the PPO makes more sense for me since I already have a specialist I want to keep seeing.
Comprehension questions
- What is the main difference between HMO and PPO?
- What is a deductible?
- What does HMO stand for?
- How much is the monthly premium for the HMO?
- What is required to see a specialist with an HMO?