In a lot of cases, our health insurance coverage comes from a group plan that is offered to you by your employer or by your spouseâs employer. For individuals who do not have insurance through their employer, individual policies exist as an option as well.Â
Of course, you can also opt for having no coverage at all, but in the case of an emergency, this could be detrimental to your financial health. No matter your age or marital status, itâs worth looking into your options for a good health care plan to protect yourself from a medically-induced financial struggle.Â
No matter what kind of plan you choose, there will always be some out-of-pocket expenses, which means youâll have some decisions to make. Deciding what type of healthcare plan to choose can be stressful, but it doesnât have to be overwhelming. In the sections below, we will discuss the key factors that play into choosing the right health insurance plan.Â
Types of health plans availableÂ
There are a lot of different terms to learn when sorting through health insurance plans, and each of them come with their own set of distinctions. Before we discuss the difference between HMOs, PPOs, POS Plans and Indemnity plans, itâs important to start with the most common types of health insurance categories:Â
- Indemnity of Fee-for-Service Plans: Health insurance plans that enable you to go to any doctor or specialist that you want without a referral are called indemnity, fee-for-service, or point of service (POS) plans. The insurance company will cover a predetermined amount of your medical expenses, and you will be responsible for the remaining balance. These plans tend to be the most flexible since there are no set restrictions on the medical providers youâre allowed to use, and you are usually not required to choose a primary care physician.Â
- Health Maintenance Organizations (HMOs): A Health Maintenance Organization (HMO) is a band of healthcare professionals and medical facilities that offer a set package of medical services at a fixed rate. This plan does require that you have a primary care physician (PCP), who would serve as the middle-man when it comes to health care. Your primary care physician would then decide whether or not seeking out a specialist is necessary. If your PCP finds it necessary for you to see a specialist, they will then issue you an in-network referral.Â
- Preferred Provider Organizations (PPOs): A Preferred Provider Organization (PPO) has the same organized care characteristic that you will get from an HMO, but with the benefit of more flexible options. A PPO allows you to seek healthcare outside of your network if you feel the need to. Keep in mind that doing so will usually cost you more in out-of-pocket expenses, but a PPO would still cover some of the cost, unlike an HMO. If having a wider variety of options is important to you, then a PPO might be a good option for you.Â
Pros and cons of each health plan
Each type of plan comes with their own implications. Ultimately, youâll have to figure out what is most important to you in order to make your decision. Letâs compare the pros and cons of each plan.
Pros: The major advantage of this type of plan is that you are able to choose where you get your medical care from and which doctor to go to, without the need for a referral or a pre-approval.Â
Cons: Indemnity plans will usually come with much higher premiums and deductibles, making them more expensive than perhaps an HMO or PPO. Another area where these plans fall short is the route you may have to take to get coverage. You may have to pay for your medical services out of your own pocket, and subsequently submit a claim to get reimbursed by your insurance company. Thereâs no telling how long this could take, and you also face the risk of not getting reimbursed at all.Â
Health Maintenance Organizations (HMOs)Â
Pros: The best thing about getting an HMO insurance plan is that your out-of-pocket medical expenses are usually pretty affordable, and you can expect to pay the same amount for each visit, depending on whether itâs a primary care physician or a specialist.
Cons: In most cases, any services that you receive from a medical professional outside of your healthcare network will not be covered with an HMO plan. Another drawback is that you have to get referred by your primary care physician in order to see a specialist. This may not be seen as a disadvantage to some, but for others it could be seen as an unnecessary extra step in the process if you already know what you need.Â
Preferred Provider Organizations (PPO)
Pros: This type of plan offers customers much more flexibility than they would have with an HMO with a lot lower rates than one might experience through an indemnity plan.Â
Cons: The main drawback with a PPO is that the out-of-pocket costs are generally less predictable.
Choosing a Health Plan is a post from Pocket Your Dollars.
AÂ healthÂ insuranceÂ policyÂ is essential for anyone seeking to safeguard their future and avoid the catastrophic consequences of high medical bills. Whether you’re buying coverage for yourself or aÂ health planÂ for your family, it’s important to get complete coverage. But despite this fact, millions of Americans remain uninsured, often because they believe one of the followingÂ health insuranceÂ myths.
Myth 1: I’m Young and Healthy; I Don’t NeedÂ Health Insurance
You’re never too young to start shopping forÂ health insuranceÂ plansÂ because you don’t know what’s around the corner.Â Medical expensesÂ can be astronomical at any age and anyone can have an accident, fall ill or be diagnosed with a serious disease.Â
It’s not pleasant to think about and many people prefer to bury their heads in the sand and live as if they are invincible, but they’re not. No one is.
Health careÂ is very expensive in the United States, there’s no escaping that fact. This is one of the few developed nations in the world where being the victim of an accident or attack could lead to insurmountableÂ medical expensesÂ and essentially ruin your life. You can’t rely on luck and you can’t assume you’ll be safe just because you’re young, fit, and healthy.
In fact, buying at this young age has many benefits, including the fact that you’ll likely clear all exclusion periods by the time you actually need to start claiming.
Myth 2: The Benefits are Lost if I Don’t Renew by the Due Date
You should always try to pay yourÂ monthly premiumÂ on time, thus avoiding any issues and ensuring you are covered at all times. However, yourÂ healthÂ insuranceÂ coverageÂ does not end the minute you miss a payment.
Insurance companiesÂ have a grace period, during which time your policy will remain active. This period allows you to gather the funds needed and to pay your monthly premium, thus keeping your policy active.Â
Typically, this grace period lasts for between 7 and 15 days, but it differs from provider to provider. Check your policy for more details but try to avoid playing fast and loose with your payments as they could be the only thing protecting you.
Myth 3: It’s All About the Deductible
The deductible is the amount of money you pay before theÂ healthÂ insuranceÂ policyÂ takes over and to many consumers, it is the single most important part of anyÂ healthÂ insuranceÂ policy. However, while it is important to consider the deductible, you should not choose your policies based solely on which one has the lowest deductible.
Look for the sort of cover that they provide and whether this will suit your needs or not, and then focus on the deductible.Â
It’s also important to find the right balance between a deductible that is cheap enough for you to afford when the time comes, but is not so cheap that it sends the premiums through the roof. To do this, avoid focusing on how much your first monthly payment will cost and ask yourself what you would do if you had to pay for aÂ medical expenseÂ today.
Would you have an issue paying the deductible? Would it require you to borrow money from friends or family? If so, it’s too high and it’s time to go back to the drawing board.
Myth 4: I Have Insurance fromÂ My EmployerÂ so I Don’t Need any Additional Cover
If your employer offers any kind of groupÂ health insuranceÂ cover, take it, but don’t assume that it will cover you for everything you need. Read the small print, look for gaps, and seek to fill those gaps with your own cover.
With your own policy, you’ll also be protected if you lose your life. If anything happens in the time it takes you to find a new job, you could be left to foot the bill, making this an even scarier and more stressful time. But if you’re covered, you can take your time as you search for a suitable role.
Myth 5: It’s Not a Pre-Existing Condition if I Didn’t Know About it
If you have any pre-existingÂ medical conditions you will be subject to an exclusion period, one that may last for up to 48 months. During this time, yourÂ insurance companyÂ will notÂ pay outÂ for any issues related to this condition and contrary to popular belief, not knowing about the condition is not enough to avoid this exclusion period.
If, somehow, it is proven that you had aÂ medical conditionÂ that was simply not discovered at the time you applied, it will still be subject to an exclusion period. The good news, however, is that you can no longer be refused because of pre-existingÂ medical conditions, which means that everyone can benefit fromÂ health insurance.
Myth 6: I Don’t NeedÂ Health InsuranceÂ If I Have aÂ Life InsuranceÂ Plan
AÂ lifeÂ insuranceÂ policyÂ can cover you for critical illness, which could be used to coverÂ health careÂ costs. You can also purchase accident and dismemberment insurance to cover you in the event you lose a limb. However,Â life insuranceÂ is designed toÂ pay outÂ a death benefit when you die. It goes to yourÂ loved ones, not you, and is therefore not a viable replacement forÂ health insurance.
For complete cover, you should look into getting bothÂ life insuranceÂ andÂ health insurance. You can findÂ low-costÂ options for both.
Summary:Â Common MythsÂ Debunked
If you don’t have anyÂ healthÂ insuranceÂ coverage, it’s time to change that and start looking for coverage today. Take a look at our guide to choosing aÂ health planÂ to get started. We also have guides on everything fromÂ life insuranceÂ (termÂ life insurance, wholeÂ life insurance, and otherÂ lifeÂ insuranceÂ coverage)Â car insuranceÂ and pretty much all otherÂ insurance products.
By purchasing all of these together you could even save some money while getting essential coverage! Just remember to do your research, plan ahead, and never settle for less than you need as you may live to regret it in the future.
Health Insurance Myths Debunked is a post from Pocket Your Dollars.