Index | Health Insurance | Health Insurance
Good health is a great asset. Radiant health has become a synonym of beauty, happiness and success, - everything people have ever strived for. We are concerned about our health, we do things for the benefit of our health, we restore and strengthen our health, and we even drink the health of people we care for. It is a universal custom to give and receive good wishes of health and well-being. Doing so, we realize that health is the most important and desired thing in life, and we generously wish our close ones good health for their lifetime.
Today, maintaining good health is getting more and more expensive. It turns out more expensive to have poor health though. Costly medical care, treatment and procedures, tests, medications, surgical and hospital treatment expenses tend to add headache to already existing health problems of a patient. Health Insurance is an efficient method to cure this headache.
You may not be able to afford expensive medical services when you fall sick without good Health Insurance. Health Insurance guarantees you that the insurer will pay the medical costs in the case you become sick due to covered causes or accidents. The US health system is practically based on Health Insurance that comes in a variety of options.
Types of Health Insurance
Most Americans use Group Health Insurance obtained at work. Usually, the employer pays a portion or all of the medical costs should his/her employee get sick. Group insurance is the least expensive Health Insurance kind. Some employers offer only one Health Insurance plan and some may offer a choice of plans. According to the Consolidated Omnibus Budget Reconciliation Act (COBRA), if you happen to change your job, you are entitled to carry your Group Health Insurance coverage with you to a new work place for the period of up to 18 months.
If you are a part-time worker or work for a small business, your employer may not offer Health Insurance, or you may find that your insurance plan is too limited. In this case, you have an option to get Group Insurance through membership in a professional association, labor union, or a club, or you can buy an Individual Policy.
There are basically two types of Health Insurance: Fee-for-Service (Indemnity) and Managed Care. Health Insurance policies may vary from low cost to all-inclusive, meeting different demands of customers. Which Health Insurance type and plan you choose largely depends on your needs, preferences and budget.
Fee-for-Service is a traditional health care policy kind. As the name implies, insurance companies pay medical staff fees for each service provided to an insured patient. Fee-for-Service Health Insurance offers a wide choice of doctors and hospitals. Choosing any doctor you trust, changing doctors any time you like and going to any hospital in the country are some of the advantages of this policy type.
Fee-for-Service coverage falls into Basic and Major Medical Protection categories. Basic protection deals with costs of a hospital room, hospital services, care and supplies, cost of surgery in or out of hospital, and doctor visits. Major Medical Protection covers costs of serious illnesses and injuries, which usually require long-term treatment and rehabilitation period. Basic and Major Medical Insurance coverage combined are called a Comprehensive Health Care Plan. It is vitally important to know your insurance policy, since some services can be limited and some not covered at all.
The insurer does not pay all your medical bills. You pay a monthly premium and an annual deductible before the health plan starts paying part of your bills. After you have met your deductible amount for the year, you start sharing the bill with your insurance company. Usually, it is your 20 percent (coinsurance) and the insurer's 80 percent. Proceeding with the payment of each bill's percentage, you reach your plan's maximum. This is the time when the insurance plan will pay 100 percent of the covered medical expenses for the rest of that year period.
In order to receive payment for Fee-for-Service claims, you or your doctor will have to fill out forms and send them to your insurer. It is important to keep track of all your medical expenses, such as receipts for your medications, etc. If your major preference in choosing health care plan is flexibility and you have no strict budget limits, you should consider purchasing an Indemnity plan.
If choosing the most suitable Health Insurance plan your major goal is to minimize costs, a Managed Care plan may be the best option for you. The basic Managed Care principle is providing lower medical costs in exchange for more limited choice. There are three types of Managed Care plans: Health Maintenance Organizations (HM0s), Preferred Provider Organizations (PPOs) and Point-of-Service (POS) plans.
The major differences of Managed Care from Fee-for-Service plans lie within two facts: the number of doctors and hospitals who participate in managed plans is limited, and you have to either find out which plans include your specialists or learn which plans your specialists have already joined. The other aspect of no little significance is that in order to keep costs low, your chosen doctor is encouraged to supervise the types of services you get and might need to approve of a hospital or a specialist you have to see, thus depriving such plans of flexibility indemnity plans offer.
Health Maintenance Organizations (HMOs) plan has an advantage of low premiums. With HMOs plan, you select a primary care physician to service your health needs and refer you to other in-network providers when required. This health care plan pays benefits only when you apply to doctors and hospitals in the HMO network. Coverage for out-of-network services is usually provided only for emergencies.
Preferred Provider Organization (PPO) is a combination of HMO plans and Fee-for-Service plans. Like in HMOs, PPO medical treatment is fully covered if provided by a doctor or hospital referring to the PPOs network. Insured individuals receive basic medical care and pay fixed premiums on a monthly basis.
Using PPO plan, you are not obliged to choose a primary care physician and do not require referrals in order to see other specialists. However, if you want to apply for medical treatment outside the plan's network, you will be paying more than people using health providers from within the PPO plan. Thus, with PPO plan, you will be able to choose between freedom of choice paying more medical bills yourself and an opportunity to recieve medical services at a lower cost from the network physicians.
Point-of-Service (POS) Plan:
If you decide to enroll in a POS plan, you will have to choose a primary care physician (PCP) from within the health care network who will supervise your health care. The primary care physician of your choice can make referrals to other providers in the plan and outside the network. If your physician makes a referral out of the network, the plan pays all or most of the bill. Members of POS plan can also refer themselves outside the plan. However, in this case your Health Insurance company will offer you only some portion of coverage. If you refer yourself to a health care provider outside the network and the medical services are covered by the plan, you will have to pay coinsurance.
With POS, you have more freedom and are not limited to HMO network providers only. Network care co-payments are quite low and there is no deductible. Paperwork for medical visits within the health care network is normally completed for you. However, there is a deductible for non-network care, and non-network co-payments are rather high. Employing doctors and services outside the network, you have to fill out the forms yourself, as well as send bills for payment, and keep an account of health care receipts.
Other Types of Health Insurance
Picking the right health plan for you, take into consideration some other, more specific Health Insurance types as well. They usually serve particular consumer needs and can be cheap or costly, depending on the policy. For instance, there is full-service Health Insurance, which covers all illnesses and allows treatment anywhere you choose, Catastrophic Health Insurance, Hospital Indemnity Insurance, Disability Insurance, Long-term and Short-term Health Insurance, etc. There are also Medicare and Medicaid, - federal Health Insurance programs.
Medicare is a public Health Insurance program for American retirees of 65 and over as well as for some disabled citizens. Medicaid is a federal program providing health care coverage for people with low income, disabled and families with dependent children. Each state normally determines who should be covered by Medicaid and what medical services should be provided.