Health Insurance: Smart planning for your healthcare
Your health insurance policy is meant to provide a safety net for you and your family when you need it. Finding the right health insurance is important to prepare yourself and your family for a crisis that may come your way due to any medical condition.
Health Insurance: What are its types?
There are primarily two types of health insurance available to individuals:
- Fee for Service: Here the insured patient can get treatment from a medical professional of his choice. The cost of treatment is then claimed by the insured or the medical provider from the insurer.
- Managed Care Health Insurance Plan: This plan is designed in such a way that it helps minimize unnecessary costs for healthcare. It may provide physicians with reasonable incentives, may control the admission of inpatients, sign contracts with selective health care providers and provide incentives to share cost for outpatient surgery. The Managed Care Health Plan is further divided into 3 types:
Health Maintenance Organization (HMO): In a Group Model HMO plan the insured patient may visit doctors, who are employees of this HMO, at a centralized medical center. The HMOs are also in contract with the Individual Practice Associations (IPAs) who also have groups of physicians or individual doctors providing health care.
The HMO may also refer a primary care physician or PCP for an insured patient who seeks a specialist's service. The patient needs to settle the co-payment as per the agreement and the rest of the cost will be borne by the insurance company.
- Preferred Provider Organization (PPO): With this type of healthcare the insured patients are entitled to receiving medical services from hospitals and other care providers in contract with the PPO. This can be done at a lesser fee. Patients seeking medical care from within the PPO network pay lesser than those seeking outside the network.
The PPO plan reimburses only 70% of the cost incurred. The remaining 30%, i.e. the difference between the amount that the plan reimburses and what the provider charges has to be met by the insured.
- Point of Service (POS): This plan also includes a network of hospitals, physicians and other care providers. Members of such plans who opt for out-of-network care get little coverage. The advantage of such a plan, however, is that it offers more choices to the members. Even if members choose a physician outside the network, they can still be covered to a certain extent.
When opting for health insurance you may either go for an individual health insurance or a group health insurance. However, there are certain differences between the two.
Are there any other health insurance options?
2 of your other health insurance options may include:
- Self-insured health plans
A self-insured health plan or self-funded plan is one where the employer assumes responsibility (with pre-conditions) to provide health care benefits for its employees. This plan is designed such that the employers pay for the out-of-pocket claim as and when they occur instead of depositing a fixed premium to an insurance providing company. Such a plan is subject to all Federal laws and Budget Reconciliation Act.
- Medicare
Medicare is a federal government program designed to insure senior citizens. You can avail the benefits provided by Medicare to secure your future. To know more click here.
How can you choose a health plan that suits you?
Before you purchase a health plan, it is important that you understand it better. Ask your insurer as many questions that you can think of. Answers to all your questions will vary from one insurance company to another. This will help you quickly compare the benefits that you are entitled to receive when you buy insurance. You may even use few of the following queries:
- What will be your monthly premium?
- Are there any discounts that you will be entitled to?
- What are the deductibles that you have to pay?
- What is the percentage of reimbursement that you will receive?
- Who/what are the laboratories, doctors, hospitals and other care providers that you can use within the company's network?
- Will your plan let you use a doctor outside their network? How much will they cover?
- What if you need to go to a specialist?
- How will your plan treat any chronic disease?
- Is there a prescription drug plan?
- Does your plan cover alternate medicines too?
A little planning always helps and may protect you from future surprises. With health insurance you can certainly prepare to face an undesirable situation arising from a medical condition. |
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