What
Is Health Insurance?
Health insurance is a type of personal
insurance that covers the medical expenses of the person covered by the
insurance policy. This can include regular check-ups, emergency doctor visits,
therapy (whether inpatient or outpatient), surgery, ...etc depending on your
individual coverage plan.
There are two different ways that health insurance
may pay for your using their coverage. The health insurance company may either
pay your medical expenses directly to the care provider, or you may pay the
care provider and the insurance company will reimburse you the percentage of
the care covered by your policy.
While health insurance is usually included in
the employee benefits package offered at the majority of workplaces your job
may not include it. If you are unemployed you should purchase your own health
insurance policy.
How
Do I Get Health Insurance?
Health insurance can be obtained by either
going through an insurance company directly or by contacting an insurance broker, an
insurance company can provide you with quotes on the costs of each insurance
plan available, however, they can only offer you what is available within their
company. An insurance broker, on the other hand, does not work for an insurance
company and is fairly well versed in all types of coverage options.
By using an insurance broker to help decide
what company you want to go through, what types of coverage you need, and
ultimately which health insurance plan you purchase, you can be sure that you
have observed all of the available options and chosen the coverage plan that is
right for you.
If you choose to go through an insurance
company, I highly recommend that you find one with a location close to your
home. This enables you to go in and talk to your insurance agent whenever you
need and skip the days of phone tag and the hour-long phone calls that drag
into your day. For example, if you live in the capital of California, you will
want to find a Sacramento
insurance company.
What
Type of Health Insurance Do I Need Anyways?
Health insurance is something that the only
one who can decide what type of health insurance you need is yourself. If you
tend to spend a lot of time in the sickbed and in hospitals you will want a
higher coverage healthcare plan, however, if you are extremely healthy and
rarely fall ill you may only need the bare minimum health coverage.
Each person is a unique individual and the
type of care you need is what determines the kind of health insurance you need.
If you choose a plan with a high monthly premium, in general, you will find
that it covers more of the cost of your visits then would be covered by less
expensive insurance plans.
If you spend a lot of time in hospitals it may
be wise of you to spend the extra money and get broader coverage, however, if
you spend negligible time in sickrooms then you will probably be better off
with a lower cost healthcare plan.
How
Do I Know Which Healthcare Options To Choose?
Many employers offer health insurance as part
of the employee benefits package, two of the most common of which are PRO
Health Insurance plans and HMO Health insurance plans. Each of these plans has
its benefits and drawbacks, and which one you should pursue depends on what
type of coverage you are looking for.
PRO Health Insurance Plans
PRO (preferred provider organization)
healthcare plans are the most common type of health insurance plan offered and
used. This type of health insurance is typically the least inclusive plan
offered; however, it is also usually the most affordable option for those
seeking healthcare.
This insurance option covers claims at the
highest percentage only for those on the company’s list of preferred providers.
What this means is that not only may you still have to pay a portion of the
doctor or hospital visit for a provider on that list, but if you choose to see
a healthcare provider that is not on the insurance company’s list of preferred
providers you will have to pay a higher percentage or perhaps the entire bill.
While this type of coverage is good for those
with a low budget and the most basic healthcare needs, those of us with more
complex or demanding healthcare needs such as people with chronic illnesses and
ailments should definitely consider a more comprehensive health insurance plan.
HMO Health Insurance Plans
HMO (Health Maintenance Organization) health
insurance plans offer more healthcare coverage than a PRO health insurance
plan. While a bit pricier than other types of health insurance an HMO plan
saves you money in the long run if you are somebody who visits the doctor or
hospitals frequently.
HMO health insurance plans cover your visits
to doctors and hospitals that have a contract through HMO to service peoples
covered through HMO healthcare plans. You are also covered to be seen and
treated by those who have agreed to provide their services to HMO members.
However, in most cases with an HMO plan, you
will be required to see a long-term primary care physician, who will have to
refer you to any specialists that you need to see. Keep in mind that any
specialists you get referred to by your primary care physician still have to
accept HMO insurance to be covered by your healthcare plan. If they are not you
will be paying the cost out of pocket and that is a fate nobody wants to face.
Purchasing
Your Own Healthcare Plan
If your work does not offer healthcare
benefits or you do not work, then you should get your own healthcare insurance
plan. Healthcare insurance requires you to pay a monthly premium but saves you
money every time you go to the doctors or to a hospital by covering part or all
of the cost associated with your visit. Whatever you choose, you may want to
consult an insurance broker
to help find the best fitting coverage for you.
Even if you don’t get sick often, you should
still purchase at least the most basic health care coverage plan, just in case.
Along with the aforementioned health insurance plans, there are a few more
healthcare plans you should be aware of.
EPO Plans
EPO (Exclusive provider organization) plans
are one of the cheapest most exclusive coverage options out there, however,
this type of plan has its downfalls such as only allowing you to be seen by
providers in their approved network in non-emergency situations.
A bonus of this type of insurance plan is that
in the case of an emergency your plan will most likely cover your visit. There
are of course, as is with all things, exceptions to this, however, most
emergency medical care will be covered by this type of insurance.
POS Plans
POS (Point of Service) plans are
semi-inclusive health insurance plans that allow you to see providers both in
and out of their network. This type of plan typically requires the person
covered to see an in-network primary care provider for preventative visits as
well as referrals to specialists.
However, you do commonly have the option, with
this type of insurance, to see an out of network provider for your regular
care, be aware though, that if you choose to see an out of network care
provider your insurance will cover less and you will pay more out of pocket
than if you had seen an in-network care provider.
Keep in mind when choosing to see a provider
that is not in your insurance company’s list of approved health providers that
you may have to pay the entire cost out of pocket, and then file the
appropriate paperwork to obtain reimbursement for the costs paid at that visit.
What
If I Can’t Afford Health Insurance?
Many people throughout the world don’t go to
the doctors or a hospital when they really need to because they don’t have
health insurance and they don’t have the money to pay for the doctor or
hospital bill. In some of these cases, they don’t survive the illness or injury
that normally would have brought them to the hospital.
Health insurance can become very expensive,
especially if you have a history of past medical problems that have a tendency
to make a reoccurrence. Even if this is the case for you, you still have
options. If you cannot afford health
insurance on your own you should apply for state health insurance such as
Medicaid.
Medicaid
Medicaid is a joint state and federally funded
program that offers healthcare to Americans who may not be able to afford it.
Low-income adults, children, pregnant women, elderly, and disabled persons are
some of the groups that can receive Medicaid benefits. If you fall outside of
these categories but still cannot find an insurance policy that you can afford
contact your local Medicaid office and ask about enrollment in their program.
Benefits Offered
Medicaid has many benefits that they offer,
however, each state is unique in that they are allowed to choose what they will
cover and what they won’t. There are some benefits that are federally required
to be supplied to Medicaid recipients such as inpatient and outpatient hospital
services, regular physician visits, labs, and X-rays among other things.
Not included in the mandatory benefits but
possibly included in the benefits offered by your state are coverage on
prescription drugs and physical therapy as well as many other benefits that may
be offered by your state.
If you would like to know what your state
offers for Medicaid benefits contact your local Medicaid office and make an
inquiry. Even if you have applied for Medicaid and been turned down in the past
if your circumstances have changed and you think you may qualify by all means
contact your local branch and ask about getting insured through Medicaid.
Things
to Be Aware Of
There are a few things to be aware of when
shopping for a health insurance plan. One thing you should keep in mind when
looking at health insurance is that most plans only cover specific doctors and
hospitals. If you have a current doctor you would like to keep seeing, then
make sure before purchasing a healthcare plan that that doctor is covered by
the policy you are looking at.
Even if the policy does cover the doctor you
want to see you should check the out of pocket percentage rates for seeing that
doctor. Many healthcare policies cover a wide range of doctors with a varying
percentage of coverage. Some doctors may have their visits covered completely,
while others only a small fraction of the total cost is covered by that plan.
Also, keep in mind that no matter what health
insurance you choose you will likely run into the problem of preauthorization.
If you do not pre-authorize a medical procedure or hospital/doctor visit with
your health care provider you run the risk of your treatment coverage being
denied even if it is covered under your health insurance policy.
Because of this, you should always when
possible pre-authorize any and every medical appointment, treatment, or service
with your health care contact person. Doing so reduces the chances that
coverage over that expense will be denied to you.
Another thing to note is that most insurance
plans will not cover name-brand medication if there is a lower-cost generic, or
equally helpful but lower-cost alternative medication available used to treat
the same illness/ailment.
The last thing you should keep in mind when
shopping for a health insurance plan is that lower monthly premiums typically
equal higher out of pocket costs, and vice versa. Keeping this in mind if you
are the one who falls ill quite frequently, or has a chronic ailment then you
will want a plan with higher coverage and lower out of pocket costs, even if it
costs more in the short term.