Health Insurance Definiton
Health insurance provides important financial protection in case of an accident or sickness. Health insurance coverage can be acquired through employers, private insurance companies, or government programs, such as Medicare and Medicaid. It's important to choose a plan that meets you and your families healthcare needs and financial situation. All health insurance plans range in terms of cost and coverage. While health insurance is needed for doctors visits and prescriptions, the main purpose for this coverage is to be protected from unexpected and high medical expenses.
What is a Deductible?
A deductible is an amount you pay out of pocket before the insurance company starts paying towards any medical expenses. Outside of a deductible, there are many other important items to look at when purchasing a health care insurance plan that will work best for you. When looking over a plan summary of a policy, you will want to look over the most important details, such as, copays, coinsurance, deductibles, and the max out of pocket. Copays are a set fee you will pay when going to the doctor, hospital, or picking up a prescription. Coinsurance is a percentage that you pay after you meet your deductible. The max out of pocket is the most you can spend in a year on your health. Any medical expenses you pay out of pocket, excluding premium, will pay towards your max out of pocket.
What is a Health Insurance Premium?
An insurance premium is the amount you pay periodically (often monthly) to maintain your insurance coverage. A premium will vary for individuals or families based on income and household size. Policy holders must pay the premium monthly for their insurance to remain active, even if they do not use it. A health insurance premium must be disclosed to you before signing up for the plan. In addition, any changes to premium or policy must be reviewed with the client so that they are made aware of changes.
Different Types of Health Insurance
There are many different types of health insurance plans. The main ones you will run into on a marketplace plan or a private insurance plan are HMO, PPO, EPO, and POS. HMO stands for Health Maintenance Organization. An HMO requires you to choose a primary care physician (PCP), and to stay within a network. With an HMO, you will need a referral to see a specialist. A PPO (Preferred Provider Organization) you can use in and out of the network. If you use a PPO out of network, there will be more costs than if you stay in network, but you do not need a referral to a specialist. An EPO or an Exclusive Provider Organization, has some of the same benefits as a PPO, but only covers outside care in emergency situations. Point of Service (POS) is a combination of an HMO and PPO. You will choose your primary care provider, but can use out of network care at a higher cost.
Marketplace Insurance
There are many different types of health insurance plans. The main ones you will run into on a marketplace plan or a private insurance plan are HMO, PPO, EPO, and POS. HMO stands for Health Maintenance Organization. An HMO requires you to choose a primary care physician (PCP), and to stay within a network. With an HMO, you will need a referral to see a specialist. A PPO (Preferred Provider Organization) you can use in and out of the network. If you use a PPO out of network, there will be more costs than if you stay in network, but you do not need a referral to a specialist. An EPO or an Exclusive Provider Organization, has some of the same benefits as a PPO, but only covers outside care in emergency situations. Point of Service (POS) is a combination of an HMO and PPO. You will choose your primary care provider, but can use out of network care at a higher cost.
