In this article, I have outlined some important factors about health insurance plan
INTRODUCTION
This article is divided into two parts
One - what to know and understand
Two - being well informed and making an informed decision
WHAT TO KNOW AND UNDERSTAND
Before you decide on a plan, you will have to understand what services are covered, the premium rate, the deductibles, co-insurance, out of pocket expenses, and co-pays. This information will help you to avoid being surprised when you receive your bill
Deductible - this is the amount of money you will have to pay out of your own pocket, before your insurance company starts paying for your medical expenses
Co-insurance - this is the percentage of the cost of your medical expenses that you will have to pay from your own pocket, after you have paid the deductibles
Out-of-pocket maximum - this is the maximum amount of money that you will have to pay for your medical expenses in a year. Once you reach your out-of-pocket maximum, your insurance company will pay for all of your covered medical expenses for the rest of the year (NOTE - the insurance company will pay only for those medical expenses which are covered under the plan)
Co-pays - these are the fixed amounts that you will have to pay for certain medical services, like Doctor's visits or prescription drugs
Covered benefits - these are those medical services which are covered by your health insurance plan
Excluded benefits - these are those medical services that are not covered by your health insurance plan
It is a good practice to track your medical expenses. This will help you to stay up-to-date on your spendings, and make sure you do not exceed your deductible or out-of-pocket maximum
BEING WELL INFORMED AND MAKING AN INFORMED DECISION
While reading your medical insurance policy, make sure you understand everything, and know specifically what is covered and what is not covered under the plan. Wherever required, do not hesitate to ask questions to the medical insurance company for clarification
It is always good to compare the benefits and disadvantages of at least 3 or 4 insurance companies, before making an informed decision. Get quotations from different insurance companies and compare the premium rates, the coverages and features, the deductibles, co-pays, and the out-of-pocket expenses
One more thing that you need to understand about your health insurance coverage is the PLAN TYPE. There are quite a few types of plans, each with its own benefits and features
Some common types are:
Type-1
Health insurance companies which require you to visit a doctor within their network for most of the services. If you visit a doctor outside their network, you will require a referral. Such companies are often known as HMO (Health Maintenance Organization). They usually have low premiums, but higher out-of-pocket expenses
Type-2
Health insurance companies which give you more flexibility to visit a doctor both in and outside their network. No referral is required for visiting a doctor outside their network. Such companies are often known as PPO (Preferred Provider Organization). For such companies, the premiums may be higher, whereas out-of-pocket expenses will be lower
Type-3
Health insurance companies which combine the benefits and features of both HMOs and PPOs. With this kind of a health insurance plan, you can visit Doctors both within and outside their network plan, but you will have to pay more for visiting Doctors outside the network. Referrals may be required for visiting doctors outside their network. Such companies are often known as POS (Point-of-Service). Overall, you may have to pay more for taking insurance coverage from such companies
Once you have gone through all the relevant details of the various health insurance plans, next you will have to consider your own individual needs, your health condition and health needs, your life style, your family situation, and your financial capabilities, before deciding on a suitable health insurance plan. Talk to your family, to your doctor, and also with the insurance provider before taking a final call
All said and done, COST appears to be the most important factor when choosing a suitable health plan. Together with cost, you will also have to consider the coverage and benefits, the network of doctors and hospitals covered, the flexibility of the plan, the costs involved in visiting out-of-network doctors, whether home care expenses are included or not
Hope I have been able to summarise all the important information in this short article. Take your best decision and go for a plan that suits you best
Click on the links below to take a look at these health insurance plans:
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