Health insurance refers to financing medical charges whereby individuals contribute to a common fund to pay part or all of their health services depending on the insurance policy. It’s estimated that an average American visits a doctor about four times a year, most of the time being for a fair checkup routine.
In the case of a severe illness, a person may have to pay a considerable amount for medical charges. It’s common knowledge that medical bills can be led to individual insolvency. This is one of the reasons why the government mandates all legible citizens to buy health insurance coverage.
Firstly the ACA ( Affordable Care Act) required that each legible citizens purchase health insurance or pay a tax penalty. However, in 2017 congress reduced this penalty to$ 0, effectively abolishing the mandate.
When to Apply for a Health Insurance
Health insurance helps you manage your health care costs and needs. Thus, it’s essential to buy health insurance if you aren’t under someone else’s health cover, such as a parent or a partner. Health insurance costs depend on several things, such as your age, where you live, income, and work.
Health plans are organized depending on the benefit they offer. They include bronze, silver, gold, and platinum. Bronze has the least coverage, while platinum has the highest. Also, other insurance brands predicate their cost depending on the level of care.
Health insurance covers are categorized into four main plans (HMOs), Health maintenance organizations, Exclusive Provider Organizations (EPOs), Preferred provider organizations (PPOs), and Point of Service (POS) plans. Additional plans include the disastrous plan and High Deductible Health Plans (HDHPs). The latter is similar to Health Savings Accounts (HSAs). In this blog, we shall discuss each of these plans so that you can choose the most suitable one for you.
Health Maintenance Organization (HMO)
This plan provides you with a local network of health care professionals, participating doctors, hospitals, and facilities to choose from. In this plan, you have the least freedom to choose your healthcare providers, and there are no claim forms to fill.
Paperwork is the least as compared to other plans. You’re also provided with a primary care doctor to help manage your health and refer you to a specialist if a need arises. In utmost HMOs, you must have a referral to see a specialist.
Doctor That You Can See
You can only see a doctor within your HMO’s network. If you go to a doctor who is out of your network, you may have to cover the entire bill yourself. If you happen to go for emergency service at an out-of-network hospital, your bills get covered at an in-network rate. However, non-participating doctors involved in your treatment at the hospital can bill you.
Payments at HMOs Plan
There are three modes of paying for the HMO plan.
· Premium: this refers to the monthly amount you pay for your insurance
· Deductible: The amount paid before your plan can cover full health care costs.
· Copay and coinsurance for every type of care received.
Preferred Provider Organization (PPO)
The PPO plan offers the following:
· Moderate freedom in choosing your health care providers. A referral is not required to see a specialist.
· Out-of-pocket cost for seeing an out-of-network doctor is much higher than seeing in-network providers.
· If you see an out-of-network doctor, the paperwork involved is more than other plans.
Doctors That You Can See
You can see any doctor in your PPO’s network; your pay increases if you see an out-of-network doctor.
Payments at PPO
Payments include a monthly premium depending on the policy; the deductible amount is higher if you see an out-of-network doctor. You may also incur additional costs if the out-of-network doctors charge more than in your area.
Paper Work Involved
If you see an in-network provider, the paperwork involved is little. However, if you see an out-of-network doctor, you will have first to pay the bill and then file a claim to the PPO to pay you back.
Exclusive Provider Organization (EPO)
The EPO offers the same freedom as PPO in choosing your healthcare providers. Also, you do not need a referral from your primary care doctor to see a specialist.
Except for emergency services, the plan does not cover costs for out-of-network doctors. The monthly Premium is less compared to PPO. You can see any doctor within the EPOs network.
Point-of-Service Plan (POS)
This plan combines the features of a PPO and HMO. It offers the following:
· Freedom to choose your healthcare providers
· If you see an out-of-network provider, the paperwork involved is moderate. You will have to pay the out-of-network provider and then submit a claim to POS to pay you back.
· You get a primary care doctor who takes care of your health and refers you to a specialist.
Doctor That You Can See
You can visit any in-network provider so long as you have a referral from your primary care doctor. You can also see an out-of-network provider for an extra cost. Payment includes the monthly Premium, deductibles, and copays or coinsurance.
Catastrophic Plan
This plan is more suitable for persons under the age of 30. It offers the following:
· Lower Premium
· The preventive care is free of charge
· You get three initial primary care visits
· For an individual, the Deductible is $8150, and $16300 for a family
High-Deductible Health Plan (HDHP)
The amount payable is less, similar to a catastrophic plan. It offers the following:
· A Health Savings Account (HSA) that assists in paying for your care. Money saved in HAS is not taxed and can cover medical expenses.
· You have to choose one of the health plans: HMO, PPO, EPO, or POS
· Similar to other plans, if you reach the maximum out-of-pocket deductibles, the plan pays for your full healthcare
· Free preventive care
· Payments are in Premium, deductibles, and copays or coinsurance
· It is necessary to record your withdrawals from HSA to know when you have completed paying your deductibles.
Conclusion
Understanding your specific healthcare needs is essential when looking for health insurance. If you require more preventive care, choose plans with lower deductibles and coinsurance for a better cost.
Health insurance refers to financing medical charges whereby individuals contribute to a common fund to pay part or all of their health services depending on the insurance policy. It’s estimated that an average American visits a doctor about four times a year, most of the time being for a fair checkup routine.
In the case of a severe illness, a person may have to pay a considerable amount for medical charges. It’s common knowledge that medical bills can be led to individual insolvency. This is one of the reasons why the government mandates all legible citizens to buy health insurance coverage.
Firstly the ACA ( Affordable Care Act) required that each legible citizens purchase health insurance or pay a tax penalty. However, in 2017 congress reduced this penalty to$ 0, effectively abolishing the mandate.
When to Apply for a Health Insurance
Health insurance helps you manage your health care costs and needs. Thus, it’s essential to buy health insurance if you aren’t under someone else’s health cover, such as a parent or a partner. Health insurance costs depend on several things, such as your age, where you live, income, and work.
Health plans are organized depending on the benefit they offer. They include bronze, silver, gold, and platinum. Bronze has the least coverage, while platinum has the highest. Also, other insurance brands predicate their cost depending on the level of care.
Health insurance covers are categorized into four main plans (HMOs), Health maintenance organizations, Exclusive Provider Organizations (EPOs), Preferred provider organizations (PPOs), and Point of Service (POS) plans. Additional plans include the disastrous plan and High Deductible Health Plans (HDHPs). The latter is similar to Health Savings Accounts (HSAs). In this blog, we shall discuss each of these plans so that you can choose the most suitable one for you.
Health Maintenance Organization (HMO)
This plan provides you with a local network of health care professionals, participating doctors, hospitals, and facilities to choose from. In this plan, you have the least freedom to choose your healthcare providers, and there are no claim forms to fill.
Paperwork is the least as compared to other plans. You’re also provided with a primary care doctor to help manage your health and refer you to a specialist if a need arises. In utmost HMOs, you must have a referral to see a specialist.
Doctor That You Can See
You can only see a doctor within your HMO’s network. If you go to a doctor who is out of your network, you may have to cover the entire bill yourself. If you happen to go for emergency service at an out-of-network hospital, your bills get covered at an in-network rate. However, non-participating doctors involved in your treatment at the hospital can bill you.
Payments at HMOs Plan
There are three modes of paying for the HMO plan.
· Premium: this refers to the monthly amount you pay for your insurance
· Deductible: The amount paid before your plan can cover full health care costs.
· Copay and coinsurance for every type of care received.
Preferred Provider Organization (PPO)
The PPO plan offers the following:
· Moderate freedom in choosing your health care providers. A referral is not required to see a specialist.
· Out-of-pocket cost for seeing an out-of-network doctor is much higher than seeing in-network providers.
· If you see an out-of-network doctor, the paperwork involved is more than other plans.
Doctors That You Can See
You can see any doctor in your PPO’s network; your pay increases if you see an out-of-network doctor.
Payments at PPO
Payments include a monthly premium depending on the policy; the deductible amount is higher if you see an out-of-network doctor. You may also incur additional costs if the out-of-network doctors charge more than in your area.
Paper Work Involved
If you see an in-network provider, the paperwork involved is little. However, if you see an out-of-network doctor, you will have first to pay the bill and then file a claim to the PPO to pay you back.
Exclusive Provider Organization (EPO)
The EPO offers the same freedom as PPO in choosing your healthcare providers. Also, you do not need a referral from your primary care doctor to see a specialist.
Except for emergency services, the plan does not cover costs for out-of-network doctors. The monthly Premium is less compared to PPO. You can see any doctor within the EPOs network.
Point-of-Service Plan (POS)
This plan combines the features of a PPO and HMO. It offers the following:
· Freedom to choose your healthcare providers
· If you see an out-of-network provider, the paperwork involved is moderate. You will have to pay the out-of-network provider and then submit a claim to POS to pay you back.
· You get a primary care doctor who takes care of your health and refers you to a specialist.
Doctor That You Can See
You can visit any in-network provider so long as you have a referral from your primary care doctor. You can also see an out-of-network provider for an extra cost. Payment includes the monthly Premium, deductibles, and copays or coinsurance.
Catastrophic Plan
This plan is more suitable for persons under the age of 30. It offers the following:
· Lower Premium
· The preventive care is free of charge
· You get three initial primary care visits
· For an individual, the Deductible is $8150, and $16300 for a family
High-Deductible Health Plan (HDHP)
The amount payable is less, similar to a catastrophic plan. It offers the following:
· A Health Savings Account (HSA) that assists in paying for your care. Money saved in HAS is not taxed and can cover medical expenses.
· You have to choose one of the health plans: HMO, PPO, EPO, or POS
· Similar to other plans, if you reach the maximum out-of-pocket deductibles, the plan pays for your full healthcare
· Free preventive care
· Payments are in Premium, deductibles, and copays or coinsurance
· It is necessary to record your withdrawals from HSA to know when you have completed paying your deductibles.
Conclusion
Understanding your specific healthcare needs is essential when looking for health insurance. If you require more preventive care, choose plans with lower deductibles and coinsurance for a better cost.
