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We all need medical attention from time to time may be due to a viral or some infection or may
be due to some accident, and some of us need it quite regularly. Health insurance is one of our most important needs- not only a need but a
necessity, Without it, one serious illness or accident could wipe you out financially.
Health care, especially in emergency situations, can be too expensive, so the answer is to get
a health insurance. As it pays for all the things -from a lab test to a hospital stay.
which could cost tens of thousands of dollars.
Health insurance is categorized into 2 broad types:
1. Group insurance:
Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. It is the cheapest
way to get an insurance cover as the employer pays a part or all the insurance cost.
2. Individual insurance:
It has various options and types, you should choose the one that suits your needs.
It has 2 major categories:
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Traditional indemnity fee-for-service plans (FFS)
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Managed-care health plans
a) Indemnity fee-for-service plans (FFS):
In this Insurance companies pay fees for the services provided to the insured people covered for the treatment of unexpected illnesses,
and completely covers your health- no matter what happen.
Advantages:
-
You can go to the doctor of your choice.
-
You may visit any specialist without getting permission from a primary care physician.
-
You, your doctor or your hospital submits a claim to your insurance company for
reimbursement.
- Patients accept responsibility for keeping medical bills and completing the claims procedure.
- You will only be reimbursed for "covered" medical expenses.
Disadvantages:
- It is the amounts of covered expenses you must pay before the insurer will start
reimbursing you for your medical bills. It may be anything from $500 to $1500.
- You have to Pay up front for medical services, and then submit the bill for reimbursement.
More paperwork.
- You will only be reimbursed for "covered" medical expenses.
Types:
- Basic health insurance
- Major Medical insurance
- Comprehensive insurance
b) Managed-care health plans: Its based on the concept of prevention is better then cure The focus is on
preventative care and keeping medical costs low.
These plans cover the cost of preventative care such as annual check-ups.
Types:
- HMO, or Health Maintenance Organization
- PPO, or Preferred Provider Organization
- POS, or Point-of-Service
- MSA, or Medical Savings Accounts
The basic features are the same for all of them:
-
You expect to pay a monthly premium.
- Yow will have to select from a network of doctors that company has tied up.
- If you go to a doctor within the network, you will pay a co-payment
and a low per visit coinsurance.
- If you choose to go outside the health care network, you will pay an annual
deductible.
The differences between each managed care plan lie mainly in the degree of compensation
you will receive.
Advantages:
- Health care costs are low.
- Paperwork is not your responsibility.
Disadvantages:
- Paperwork is your responsibility if the care is non-network.
- If you see an out-of-network doctor, you might have to pay the entire bill yourself, and then submit it for reimbursement.
- You might have to pay a deductible if you choose to go outside the network, or pay the
difference between what network doctors and out-of-network doctors charge.
Cost of health insurance:
- Premium: It is the monthly fee for coverage. Premiums can vary depending on your level of coverage.
- Deductible: It can be anywhere from $500 to $1,500. These are amounts of covered expenses
you must pay before the insurer will start reimbursing you for your medical bills.
- Co-payments and Co-insurance: Both require that you pay a small part of each medical cost.
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