"He who has health has hope, and he who has hope has everything." To the millions of Americans struggling with a medical issue, condition or illness, hope comes in the form of health care insurance. Numerous studies have shown that the combination of a steady source of care and health insurance contribute to a higher quality of life and an enhanced physical and emotional well-being. Conversely, the consequences of being uninsured and not obtaining health care are detrimental to individuals' health. Due to soaring medical expenses, Americans lacking health insurance are twice as likely to not obtain the needed care as their insured counterparts. When the former do seek medical care for a serious injury, accident or illness, the care is prohibitively costly due to the lack of prevention. Therefore, health insurance coverage is a valuable investment that protects policyholders and their families from financial peril in the event of a catastrophic illness or unexpected injury.
An optimal health insurance plan is one that best corresponds to the patient's health needs, provides the most benefits at the most affordable price, and offers the greatest flexibility. Consumers may choose from a wide array of health insurance plans featuring diverse levels of coverage, benefits, and fees. Health insurance typically falls into one of the following categories:
1. Indemnity Plans, also referred to as reimbursement or fee-for-service plans
Under this type of
insurance plan, members are not restricted to a network of doctors but choose their own physicians and hospitals. Also, they need not request a referral to obtain care or select a primary care physician. This kind of health insurance policy reimburses patients' medical expenses partially, in whole, or up to a certain per diem amount for a specified period of time.
2. Managed Care Plans, which consist of PPO (Preferred Provider Organization), POS (Point-of-Service), and HMO (Health Maintenance Organization) plans
Managed care plans typically offer broad health insurance coverage and involve arrangements between a selected group of participating physicians or health care providers and insurance companies. PPO policyholders usually make a small co-payment per medical visit. Some services require payment of co-insurance or a deductible. Preventive care, such as mammograms, immunizations, and baby care are covered by most PPOs. Policyholders may choose physicians who are not part of the PPO network. However, by selecting doctors who are part of the plan, the insured can expect their provider to foot a large portion of their medical bills. POS plan members are not required to pay a deductible; rather, a small co-payment is charged for each medical visit. POS policyholders must select a primary care physician, who in turn refers them to a specialist or other physician if necessary. Members are required to stay within the POS plan's network of physicians.
Another type of managed care plan is the HMO, a prepaid plan which allows the insured to receive treatment from a list of pre-qualified health care providers. Policyholders are only covered if they remain within the network. Comprehensive care is available for services ranging from therapy, physicals, immunizations, hospital stays, and office visits to x-rays, lab tests, surgery, and emergency care. Pursuant to an HMO plan, a primary care physician manages the care provided to the policyholder and refers him or her to a specialist in the network. HMO members pay a monthly premium which covers most health expenses each month, regardless of the quantity of care needed. Since the ensemble of services covered by an HMO tends to vary, consumers should compare plans. Policyholders may have to make a small co-pay per office visit, with the amount charged being dependent on the type of treatment they receive.
3. Short-Term Health Insurance
Consumers may purchase policies that offer health insurance coverage ranging from comprehensive to catastrophic. Short-term health insurance provides coverage for a specific period of time. Pre-existing conditions, as well as childbirth and pregnancy, are generally not covered by this health insurance policy.
Prospective policyholders should ensure that their health insurance plan provides the services and coverage needed. Typically, a beneficial health insurance policy provides the following types of coverage:
- Hospital Expense Insurance (also known as "basic coverage") - covers the costs of hospitalization (room and board) and care, supplies such as prescriptions and x-rays, and incidental services
- Physicians' Expense Insurance - covers a physician's hospital visits or visits to a doctor's office
- Major Medical Insurance - covers the cost of serious injuries or illnesses and provides extensive coverage
- Surgical Expense Insurance - pays surgeons' fees and costs relating to surgery
Consumers may opt for a comprehensive plan, which consists of major medical insurance and basic insurance coverage combined. When shopping for health insurance, consumers should check the policy for a listing of covered services. Common exclusions include vision care, maternity care, mental health care, preventive care, and/or prescription medication. Health insurance premiums may be paid annually, quarterly, or monthly. Prospective policyholders should find out whether the health insurance plan in question requires them to pay:
- Deductible: - Sum that the insured must pay for covered services before the provider begins paying claims (usually required by indemnity plans)
- Coinsurance - Sum that the policyholder must pay for health care after he or she has satisfied the deductible;
- Co-payment - Flat fee that the insured must pay each time he or she receives a medical service (usually required by HMOs)
Consumers may choose between group and individual health insurance plans. Group health insurance coverage is usually available through one's employer and other affiliations such as chambers of commerce, trade associations, schools, and clubs. Group insurance plans usually offer lower health insurance rates and more comprehensive coverage than individual plans. On the other hand, individual insurance plan policyholders may decide which provisions to include or exclude and choose their co-payment percentage and deductible amount.
Consumers may shop online for a low health insurance rate and purchase a policy by completing a simple, secure, and quick online application. Free, instant online insurance quotes are available from a multitude of leading insurance providers nationwide. Prospective policyholders may compare rates from numerous companies by entering their zip code and selecting between various insurance types including cheap car insurance, homeowners insurance, life insurance and more.