Need health insurance and looking for affordable health insurance coverage? For many people finding health insurance is easy as calling a provider however choosing the right type of health insurance and finding affordable coverage is the challenge.
What is a PPO, a HMO, Policy Limit or even a Co-Pay?
Finding the right health insurance plan for you and your family takes some research and you need to spend the time learning how health insurance works well before committing to a policy. Even company sponsored health insurance plans have multiple options which are sometimes favored more towards the cost of insurance rather than the actual benefits provided.
Are you better choosing an independent plan in lieu of your company plan? How much is health insurance per month? How are pre-existing conditions covered?
Is cost the most important factor to consider?
Everyone who has to purchase health insurance wants a low-cost plan that covers all medical expenses. Unfortunately, too many people look at cost and fail to realize that the plan in question may not meet their needs. Health insurance that does not cover you when it is needed is not a bargain at any price!
What should you look for in a health insurance policy to determine if it is right for you? There are several things that are important when you are shopping for health insurance, besides the cost of the premiums.
Determine the Type of Coverage
First, you must determine exactly what the plan covers. For example, major medical is usually fairly inexpensive. Plans can be had for as little as $25 a month. However, major medical does not cover doctor visits, medication, or wellness issues. Therefore, if you visit the doctor on a regular basis, you are going to be paying for those visits out of your own pocket. If you regularly take medication, expect to pay full price. While different carriers have different types of major medical, most only cover you if you have to be hospitalized or have some emergency trauma. Even then, they may pay only a portion of those costs.
Far more useful for most people are regular health insurance plans with deductibles and co-pays. These allow you to visit the doctor, get your medication (if a pharmacy plan is included), and have regular tests, such as x-rays or mammograms, run, and the policies will pick up at least a portion of the bill. Before you sign on the dotted line, however, do some calculations to figure out if the plan is right for you, and how much you will actually be paying out of pocket.
Understand the Policy Deductible
Higher deductibles mean lower premiums; however, if you put your deductible too high, you can have problems if you have a medical need and cannot meet the required payments. If you have a high deductible, you should allow for the deductible in your monthly budget to be sure you can cover your portion of the costs. A health insurance savings plan can help you save toward this goal, and do it tax-free. However, certain conditions must be met for the money to remain untaxed. Talk with your employer or a financial advisor about whether a health insurance savings plan would benefit you.
How does the policy Co-Pay work?
If your deductible is manageable, the next thing you must look at is your co-pay. Co-pays are amounts in addition to the deductible that you must pay at the time of medical service. For example, your co-pay may be $20 for a doctor visit. That means that when you arrive at the doctor’s office, you will be required to pay $20 for the visit, even if your insurance picks up the rest of the bill. Most doctors expect this co-pay to be made at the time of service, although some will bill you for the amount. A high co-pay means that you will be paying money every time you visit the doctor. Prescriptions may also have a co-pay; even if you use generic drugs, these co-pays can add up if you take any medications regularly.
What percentage will the Health Insurance cover?
Always look at the percentage offered by your plan to cover various medical expenses. Most plans use a sliding scale; some treatments are covered at one percentage, and others at a lower percentage. For example, your plan might pay 80% of reasonable costs for doctor visits and routine hospital care after your deductible is met. However, the plan might pay only 50% of what it considers “extraordinary” expenses. Only your plan’s literature can tell you what the company considers routine and extraordinary.
In-Network vs Out of Network
Another thing to watch is what your plan says about “in-network” service vs. “out of network” service. If your plan has a network, it may require you to use only doctors participating in that network. If you go to a doctor or hospital that does not participate in the plan’s network, your plan might not pay anything at all, or may pay only a reduced percentage.
Reasonable and Customary Charges
Additionally, most plans pay what they consider to be “reasonable and customary” charges for services. This can be a bone of contention between doctors, hospitals, and the insurance provider. Some cheaper insurance plans demand that “reasonable and customary” expenses be assessed at far less than the doctor or medical provider usually charges. If the plan refuses to pay any more, you may be responsible for the difference. It is important to talk with your doctor about what your plan covers and what the doctor charges before you receive medical treatment.
Finding affordable health insurance is possible but the cost of insurance is just one factor. Only the best combination of coverage, cost and provider will ever ensure all your family needs are met.
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