Getting Health Insurance is a good way to cover up all your surgical, medical, drug prescription, and dental expenses. In some cases, the health insurance can pay directly to the care provider and in other cases, it is reimbursed to the person insured. However, different types of health insurance are suitable for people based on their age, family history, etc.
What is a Health Insurance?
An insurance that is covering the entire or some part of the possibility of a person undergoing medical expenses. An insurer assigned by the insurance company estimates the entire health risk of the person and the expenses related to them over the pool of risk. He then develops a regular finance structure known as the payroll tax or monthly premium. This payroll tax or monthly premium is then provided to pay for the benefits related to health care which are specified in the agreement of the insurance policy.
In most cases, the benefit packages given by the employer to its employees comprise Health insurance programs. This is a way of attracting efficient and qualified employees. Often the health insurance programs provided by employers have the premiums partially paid by the employers but in some cases, these premiums are partially deducted from the paychecks of employees.
The health insurance premium cost is deducted from the payer usually, while the benefits that he receives are tax-free. However, these health insurance plans can become very tricky when you are choosing them as they may have a lot of rules considering the in and out network services, co-pays, deductibles, etc.
The good news for families having children is that the Affordable Care Act has asked the insurance companies to let the children be covered for their medical and health expenses under their parent’s insurance plans until they reach the age of 26. This was announced in 2010. Moreover, the Affordable Care Act has also forbidden insurance companies to deny insurance to people who have pre-existing medical conditions.
Also, there are public insurance programs such as the Children’s Health Insurance Program and Medicare health Insurance program which are meant for children and individuals who are old. These plans also cover entirely or partially disabled people.
Understanding Health Insurance Plans
The benefits of health insurance plans can be tempting but when you are getting one, it can become really tricky. There are a lot of considerations involved in getting a good insurance plan. Usually, the managed care insurance plans have a requirement that the policyholders will be covered for the most expenses only if they get the care from a designated network of healthcare providers. However, if the policyholder or the patient wants to seek care from a health care provider that does not belong to the network designated by the insurance policy then they would have to pay a greater amount of the expense. There is also a possibility that the insurance company denies payment for health expenses if you seek healthcare services from healthcare providers that do not belong to the designated network.
Point of Service Plans and, Health Maintenance Organizations are such Managed Care plans. These require their policyholders to select a physician for primary care who can check the patient, make suggestions regarding the treatment, and give referrals for specialists for their medical condition.
However, A managed care plan known as Preferred Provider Organizations does not have this requirement but does have lesser rates for choosing network practitioners and their services.
Before signing a health insurance policy, you must be aware that insurance companies in some cases also reject providing coverage for services that are received without getting authorization. In many cases, insurance companies could deny paying for drugs that are branded in a case where you could take a drug that is available at a lower rate.
All these criteria are written in the material the insurance companies provide. Therefore, you must review every piece of material properly. It is advised that before you incur an expense, you shall check with the insurance company or the employers if it falls under the policy or not.
Public health services are complex and financed by federal state, local and private sources that vary across communities and fluctuate over time depending on other factors like budget and decision of state and federal government.it is estimated that the United States spend 3 to 9 percent on Public health (Mays GP, 2011).
Benefits of Health Insurance Plans
As we talk about health insurance plans, you may have a thought that how can health insurance be beneficial for you. Not only health insurance policies work as a protective measure for your family as well as yourself from the financial expenditures but it also has many other benefits.
When you sign for a health insurance, all your visits to the doctor, emergency room trips and treatments from specialists are paid by the insurance company. It depends on which health insurance you choose. There are certain health insurances which cover hospital bills for big hospitals in case of surgery and major treatments.
Here are five major advantages of signing for a Health Insurance Plan:
- Medical Expenses are covered
When you choose health insurance, you can get the best health care without any trouble and financial burden. Your high medical costs are covered such as daycare procedures, ambulance charges, hospitalization expenses, domiciliary expenses, etc. This would let you pay attention to your quick recovery rather than focusing on how you will pay for the medical bills.
- Critical illnesses Coverage
There are insurance plans are meant for covering critical illness expenses. Such plans would provide you coverage against critical illnesses such as stroke, kidney failure, loss of limbs, and bone marrow transplant. In case you get diagnosed with an illness among the list that is predetermined in your policy then you can get a good amount for the medical expenses. You can meet your daily expenses, financial obligations, and illness-related costs with this amount.
- You get a cashless claim benefit
Some health insurance policies can provide you with a cashless claim facility so that you do not have to spend from your pockets. Any hospitalization expenses would be settled between the hospital and your insurer. However, for this claim, you must be admitted to the network of hospitals mentioned by the insurance company. To enjoy this facility, you just have to fill a pre-authorization form and show your health insurance card to the hospital.
- You get additional protection
Employers offer health insurance to their employees. However, that may not be suitable for your needs and you may remain uninsured in case you lose your job. In such a case, it would be wise to sign up for health insurance privately.
- You get tax benefits
You can get a lot of tax benefits by purchasing health insurance plans. For example, you can get tax deductions on the premiums you pay for the health insurance plan.
Some Considerations of Health Insurance Plans
Co-pays, deductibles, coinsurance are some considerations of health insurance plans. Co-pays can be referred to as the fees that the subscriber of the plan shall pay for certain services like prescription drugs and visits to the doctor.
Deductibles are fees that the policyholder must meet before the insurance company covers the claim. Whereas, Coinsurance is a certain percentage of the cost of the healthcare which is to be paid by policyholder even after they have paid the deductibles.
The insurance plans that have a greater amount of out-of-pocket costs, usually have a lesser amount of premiums per month and, have low deductibles. When you are choosing a health insurance plan, you must look for benefits that have low costs per month as compared to the risk of paying a greater amount of out-of-pocket expenses in a case where you come across a major accident or a serious illness.
For people with other medical disabilities, there are other plans such as disability insurance, long-term care insurance, and critical illness insurance.
President Barack Obama in the year 2010 signed the Patient Protection and Affordable Care Act which asked the insurance companies to let the children be covered for their medical and health expenses under their parent’s insurance plans until they reach the age of 26. Moreover, it also forbids insurance companies to deny insurance to people who have pre-existing medical conditions.
In other states, this act was expanded to Medicaid. This is a government program that gives care medically to people who have low incomes. The Affordable Care Act also established a marketplace for federal healthcare. This marketplace assists businesses and other people to buy insurance plans that are of high quality but at nominal rates. People who have low incomes, purchase health insurance plans from this marketplace and hence get qualified for subsidies that bring the costs down.
What the Marketplace covers?
The Marketplace covers a lot of health benefits. The following are ten health benefits that it covers:
- Emergency services
- Ambulatory Patient services include the care of outpatients that is given by health care providers for patients that are not admitted to the hospital.
- Surgery and overnight stay in the hospital or Hospitalization.
- Before and After pregnancy, newborn, and maternity care.
- Psychotherapy and counseling are known as behavioral health treatments. Substance use disorder and mental health disorder services.
- Prescription drugs
- Laboratory services including blood tests etc.
- Habilitative and rehabilitative devices and services. These include the devices and services which are meant to assist people with disabilities, chronic conditions, injuries and, physical & mental skills recovery.
- Management of chronic diseases, wellness, and preventive services.
- Vision and Oral care are included in pediatric services.
Some Additional Benefits:
Not necessarily but the plans may include these coverages as well:
- Coverage for birth control
- Coverage for breastfeeding
Although the above ten benefits are the minimum a marketplace will include but depending on the state’s government you shall get additional benefits such as:
- Coverage for vision services
- Coverage for dental services
- Management programs for diabetes, weight management, and back pain.
What is a High-deductible Health Plan?
High-deductible health plans are extremely popular. These plans had compulsory deductibles of about $1400 minimum for a person and $2800 for an entire family. It had a mandatory out-of-pocket amount of $6900 maximum for a person and $13,800 for an entire family.
As compared to a health insurance plan that is equal in terms of benefits and other things along with a low deductible, a high-deductible health plan has low premiums.
If you choose to have a high-deductible health plan, you get to open and add the pre-tax income to the health savings account. This account could be later used for paying for your medical expenses.
What are Insurance Deductibles?
Deductibles depend on which insurance policy you have signed for. They can vary from hundreds to thousands. Your selection of signing an insurance plan with a high deductible or choosing an insurance plan with no deductible or opting for a plan with a moderate deductible should be based on the health care needs that your household and budget require.
Deductibles work like: You pay first and then it is them who pay. Talking in terms of insurance plans, initially when the insurance company even begins to pay for your healthcare, there is a requirement that you have to pay for your medical expenses totally till the time your deductible is paid. For example, if the insurance plan that you have signed for has a deductible of $1000 then until and unless you have made $1000 payments for your medical services, the insurance company would not bear your health care expenses.
What does No-deductible mean on your Health Insurance?
Now as you have understood how deductibles work, you would be curious to find out that what does “no-deductible” means. It means that the insurance company with whom you have signed the plan, would pay for your healthcare claims right away and you will not have anything to pay for the treatment. As we discussed earlier, deductibles are the amount of payment that you got to bear out of your own pocket when you claim for coverage. It is a way to lessen the premium of insurance. It is because the policyholder is ready to bear a few of the health risks before when the insurance company starts paying in full.
However, your insurance plan would be more costly when you have a low deductible amount. However, in the case where you choose a no deductible, all the costs would be borne by the insurance company.
Let’s say for suppose, you opt for a deductible amount of $250. Now you will be required to pay the initial $250 expense of a health insurance claim. This amount will be paid by you directly to the doctor, clinic, or hospital when you are having the treatment. It means that if your treatment’s expenditure is $500 then you will have to pay the initial $250 and the insurance company will pay the rest for the treatment.
However, this amount will be paid by you only once during the claimed coverage, despite the number of claims.
Should I choose a No-deductible health Insurance Plan or a High Deductible Insurance Plan?
People who select a high deductible plan, do so because it would let them have lesser premiums every month. Moreover, they would get a Health Savings Account which would let them and their employer deposit an amount that would be pretax dollars to spend on medical expenses.
However, if you are healthy and do not have any possibility of getting hurt, it is appropriate for you to sign for a high-deductible plan. But in case your profession can cause you any health risk like if you are a race car driver or a wrestler then you must not choose a high deductible plan.
What is No Charge after deductible?
No Charge after the deductible is a common phrase used by insurance companies on the material, they give you at the time of signing a policy. In case you are confused, it refers to the fact that you will only have to pay the deductible once a year, and once you have paid for it, the insurance company would be fully liable to pay for the future health care expenses depending on the policy limit.