How to Choose a Professional Health Insurance Plan
One of the biggest stories today is health insurance coverage in America.
In fact, an estimated 45 million Americans are without health insurance coverage, and this number is projected to reach 54 million by 2019, according to the Congressional Budget Office.
Being without health insurance is a big deal - those without health insurance are significantly less likely to seek preventative health care and finally seek care only when their health condition becomes dire.
Additionally, many people struggle financially when hit with unexpected health problems, many of whom end up declaring bankruptcy or losing their homes.
For these reasons, finding affordable health insurance is essential, and the best way to find affordable health insurance is to shop around.
What to Ask When Shopping for Health Insurance
The Insurance Information Institute recommends that consumers ask the following questions when comparing health insurance plans:
- What is the plan's monthly premium?
- What are the plan's deductibles that will have to be paid out-of-pocket?
- Once deductibles have been met, what percentage of medical expenses will the plan reimburse?
- Are the policyholder's preferred doctors, hospitals, laboratories and other health care providers included in the insurance company's network?
- How much will the plan reimburse if the policyholder uses physicians outside of the insurance company's physician network?
- Will the plan even allow the policyholder to see a health care provider outside of the insurance company's network?
- Is the policyholder able to change his or her primary care physician and if so, how?
- What procedures must policyholders follow in seeking emergency care?
- Will the plan cover preexisting conditions, and what does the insurance company consider to be preexisting conditions?
- How with the plan treat chronic conditions, such as asthma or cancer?
- Are the policyholder's prescription medications covered by the plan?
- Will the plan cover alternative medical therapies, such as acupuncture or chiropractic care?
- What is the plan's coverage for maternity care and delivery?
Health Insurance Plan Choices
When shopping for a health insurance plan, you will need to choose between two primary types of plans: indemnity plans, which essentially are fee-for-service plans, and managed care plans.
There are five primary types of indemnity plans from which you can choose:
- Cafeteria/Flexible Spending Plans: Employer-sponsored plans that enable employees to design their own health care package.
- Indemnity Health Plans: These plans allow policyholders to go to any doctor, hospital or health care provider. The policyholder often is required to meet a deductible and to pay a percentage of every bill.
- "Basic and Essential" Health Plans: These plans offer much lower premiums than other types of health care plans but they often do not cover some basic treatments, such as chemotherapy or maternity care.
- Health Savings Accounts: An alternative to traditional health insurance plans, health savings accounts allow individuals to establish a tax-free savings account to cover out-of-pocket medical expenses.
- High-Deductible Health Plans: Often referred to as catastrophic health insurance coverage, these plans offer inexpensive premiums but will initiate coverage only after a comparatively high deductible has been met.
When it comes to managed care options, there are three primary types from which to choose:
- Health Maintenance Organizations: Typically referred to as HMOs, these types of plans provide policyholders access to an extensive network of participating physicians, hospitals and other health care facilities and providers.
- Point-of-Service Plans: These types of plans, commonly called POS plans, are similar to indemnity plans - policyholders typically are able to see health care providers outside of the plan's network if they choose to do so.
- Preferred Provider Organizations: These types of plans, commonly called PPOs, work on a fee-for-service basis, in which participating health care providers are paid by the insurer on a negotiated, discounted fee schedule.
