The essential
While most people understand the importance of having health insurance, many don't know much about it. Below is some basic information about health insurance to help you understand this basic product.
Types of health insurance
There are two main types of health insurance:
- Service fee: patient care is provided by the doctor of your choice. The patient or healthcare provider claims and pays the medical specialist fee for each service provided.
- Managed care: Most Americans have a managed care plan. There are different types of managed care plans. These plans provide comprehensive services and offer financial incentives to patients who use the plan's service providers, also known as "network." The most common types of managed care plans are HMOs and Preferred Organizations (PPOs).
Health fund
Members of the patient's fund must choose a primary care physician. When requesting treatment, members must obtain a referral from their primary care physician to obtain services from another network physician. Because the cost is spread among a limited number of members, sickness funds can be less expensive than PPOs. However, the costs of services provided by the physician outside of the HMN network may be much higher, resulting in higher out-of-pocket costs for the patient.
PPO
Like HMO in Structure, PPO members have more flexibility in choosing services provided by doctors outside of the plan's network. PPOs may include additional benefits, such as prescription drug plans. The PPO premium tends to be higher than the sickness fund.
There are advantages and disadvantages to each of these health insurance plans. The choice between the two should only be made after careful review of each plan's benefits, for example, network size and accessibility, and limits, including out-of-pocket costs.
Individual plans versus groups
Many Americans join the group health insurance plan offered by an employer or other organization. Group plans tend to be less expensive and offer broader coverage than individual plans.
Those who are unable to obtain group health insurance or who choose to drop group coverage can purchase an individual health insurance plan for themselves and their families. While individual policies can help control the cost of health care, they are generally more expensive and more restrictive than group plans.
What you pay
Health insurance plans generally include a discount or copayment for services. This is the amount you will pay out of pocket for services before you pay for insurance coverage. Discounts may vary depending on the service provided. For some services, the policy may include currency insurance - this is the percentage cost that you will pay out of pocket against the percentage that the insurance company pays. Before choosing a plan, carefully review the limits of different types of services and make sure you understand any special expenses. Choosing higher discounts, copayment percentages, and coin insurance means more cost than your pocket; However, this will also reduce your total premium.
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