Make an informed decision on your personal health care insurance. Read this guide to understand the different options and factors to consider.
Personal health care insurance is a critical aspect of our lives that helps us in case of medical emergencies. With the increasing cost of medical treatments, it becomes imperative to have a health insurance policy in place. With various options available in the market, choosing the right one can be a daunting task. This article will provide you with a comprehensive guide to help you understand the different options available and make an informed decision.
Understanding the Different Types of Personal Health Care Insurance
Health insurance can be broadly categorized into two categories – individual health insurance and group health insurance.
Individual Health Insurance:
Individual health insurance is a policy that is taken by an individual for themselves and their family. The policyholder is responsible for paying the premium, and in case of a medical emergency, the insurance company pays for the medical expenses.
Group Health Insurance:
Group health insurance, on the other hand, is offered by an employer to its employees. The employer pays a portion of the premium, and the employees are responsible for the rest. Group health insurance policies offer a broader coverage compared to individual health insurance policies.
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Factors to Consider While Choosing a Personal Health Care Insurance Policy
The following are the factors that you need to consider while choosing a personal health care insurance policy.
- Coverage: The first factor to consider is the coverage offered by the policy. You need to ensure that the policy covers all the medical emergencies that you and your family may face in the future.
- Premium: The premium is the amount that you need to pay for the policy. You need to consider your budget and choose a policy with a premium that you can afford.
- Deductible: The deductible is the amount that you need to pay before the insurance company starts covering your medical expenses. You need to consider the deductible and choose a policy with a deductible that you can afford.
- Network of Hospitals: You need to ensure that the policy you choose covers the hospitals that you prefer.
- Pre-existing Conditions: You need to ensure that the policy covers pre-existing conditions.
Understanding the Different Options Available
The following are the different options available in the personal health care insurance market.
- HMO: HMO stands for Health Maintenance Organization. It is a type of insurance policy that requires you to choose a primary care physician. The primary care physician is responsible for referring you to specialists in case of a medical emergency.
- PPO: PPO stands for Preferred Provider Organization. It is a type of insurance policy that allows you to see any doctor without a referral.
- EPO: EPO stands for Exclusive Provider Organization. It is a type of insurance policy that allows you to see any doctor within the network without a referral.
- POS: POS stands for Point of Service. It is a type of insurance policy that allows you to see any doctor without a referral.
Personal health insurance is available in many variations; while good coverage will probably not be quite as cheap as group coverage, you still should be able to find something affordable that will protect you from the extreme costs of having no coverage at all.
Federal laws protect those who have had group coverage
If you have had group coverage for the past 63 days, you are entitled under a federal act referred to simply as COBRA to keep your group coverage and pay it yourself for up to 18 months. This period is extended to 3 years if you are disabled. Be prepared for a much higher cost than you are accustomed to, however, as your employer will no longer be sharing the premium with you.
Another federal act referred to as HIPPA says that no company can turn you down, regardless of your health if you have not been without group coverage for more than 63 days. HIPPA does not, however, control the premium for the coverage. If a company doesn’t want to cover you, they can simply charge you a premium you can’t possibly afford.
Coverage varies according to the plan a company offers
Under group coverage, you may have had few choices, and therefore may not be aware of the many variations of coverage. Generally speaking, you have indemnity plans also called “fee for service,” and managed care plans called HMOs.
The indemnity plan is traditional insurance. You go to a doctor of your choice; he charges a fee for his service and you pay a part of it, called a co-pay. The insurance pays the remainder according to a schedule of “usual and customary” rates which vary from place to place.
The opposite of the fee for service is the HMO. In this type of plan, you have a primary care doctor and cannot see any other doctor without a referral from the primary provider. Many people do not like the restrictions of the HMO, but these plans are usually more affordable than traditional coverage. They do not, however, guarantee any better coverage than a traditional plan.
A third type of plan that blends traditional insurance with the HMO is the PPO, or Preferred Provider Organization. In these plans, you can see any doctor in the network without a referral from a primary care physician. You can also go outside the network, but will pay a higher copay, and you may even have a separate deductible.
Finally, there are some catastrophic coverage plans that do not pay for doctor visits at all, but only pay if you are admitted to a hospital. Some plans which are not considered “catastrophic” simply have such a high deductible that you are not likely to use the insurance unless you do have an accident or major illness. These plans will usually be a cheap alternative.
Finding the best plan for yourself
Unfortunately there is no standard personal health insurance plan; the only way to find the one that is right for you is to consider your current health, the risks you are able and willing to take, and look for a plan that will provide health coverage at a price you are willing to pay. Usually, a knowledgeable agent can help you understand the terms of any company policy.
FAQs on Personal Health Care Insurance: Explore All Your Options
Q : What is personal health care insurance?
A : Personal health care insurance is a type of insurance policy that helps you in case of medical emergencies.
Q : What are the different types of personal health care insurance?
A : The different types of personal health care insurance are individual health insurance and group health insurance.