Affordable Individual Health Insurance - How To Control Your Own Insurance Costs
What kind of health coverage do you currently have? Are you satisfied with it? Do you know what your deductibles are, how much they cost, and what your out-of-pocket maximum is on each plan? If not, then this article is for you.
We want to help you get the most out of your healthcare-- and that's why we're going to teach you about Affordable Individual Health Insurance. We'll discuss how to control your own insurance costs so that when it comes time to spend money on doctor visits and hospital stays, the surprises will be few and far between. We'll also explore ways in which this type of insurance differs from other types of coverage. If you're confused by the terms deductibles, coinsurance and out-of-pocket maximums, then you'll be relieved to know that we'll provide an easy explanation of each.
Health Insurance Basics
Health insurance is a contract made between an insurance provider and policyholder. The policyholder (you) promises to pay a specified amount of money each month and in return, the insurance provider will provide coverage for healthcare services and procedures. Health plans are categorized into 4 types depending on how they reimburse patients for covered medical services: Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Point of Service (POS) or Indemnity. (PPO)
Some individuals prefer to have their health insurance provided through a company that they know and can work with. This type of insurance is a PPO. With a PPO, you are most likely to be able to choose which doctors you will use, and your plan will cover the cost of most medical services.
You pay the same amount each month whether or not you choose to see a particular doctor or go to the hospital. You are not required to use the same doctor who your employer has enrolled in your plan. (The only exception is that if your employer chooses one doctor for all of its employees, then that general physician will be the only one who can treat you. If you have a PPO, but your employer chooses one doctor for everyone and you do not want to use that physician, then you can find another physician who accepts your plan and is covered by the same network. However, your employer will probably pay less under this arrangement.) In most cases, if you want to see a specialist or go to the hospital, then you are free to do so as long as the doctor is within your plan's network.
PPO plans usually cover 90% of all covered medical costs. 10% of the cost will be left up to the policyholder in what is known as a deductible. That is, if you visit your primary care physician and get treated for a cold, then your deductible will apply because it is considered to be a preventative medical service. If you go to the emergency room and receive treatment for a broken arm, the deductible will not apply because a broken arm is considered an emergency. Once you have reached this amount in costs that your insurance company has agreed to cover (the total cost of all of your visits and treatments including the deductible) then you are said to have reached your out-of-pocket maximum for that year. This point is also known as "spending down to zero" or "expending all of your benefits".
Health insurance providers will set a limit (out-of-pocket maximum) on how much they are willing to pay toward your healthcare services and treatments. These plans may require that you pay coinsurance, which is a percentage of the treatment cost. Coinsurance rates can range from 20% to 50%, depending on the plan. The insurance company is paying 80% and you are paying the remaining amount.
Individual Health Insurance Plans
As mentioned above, individual health insurance plans allow policyholders to choose their own doctors and medical facilities for care. If you want to use your employer's PPO plan for coverage, then you will most likely have to pay an additional surcharge in addition to your monthly premium. Individual health insurance plans on the other hand, will not require a surcharge. In most cases, individual health insurance premiums are going to be lower than those of other types of coverage. However, some individuals are concerned with being able to choose what type of doctor they want to use. They do not want to have their employer pick one doctor for them and they have no interest in a PPO plan.
Individual health insurance plans also differ from PPOs on the out-of-pocket maximum level of coverage. In most PPO plans, 10% of the costs are paid by the policyholder in what is known as a deductible. After the policyholder meets their annual deductible, then their insurance provider will cover 90% of all covered medical expenses. In a typical individual health insurance plan, you will pay 100% of all covered medical costs until your out-of-pocket maximum is reached.
No matter what type of health plan you are considering, whether it is an individual health insurance policy or a PPO provided through your employer, you should be aware that the following services may not be covered by your healthcare plan: routine exams such as annual checkups and pap smears, cosmetic surgery that is not related to reconstructive or plastic surgery for a medical condition, and elective procedures such as Lasik Eye Surgery.
Perhaps one of the most confusing terms associated with health insurance is out-of-network. This is a term that applies to your insurance policy but has nothing to do with being out of network on an online gaming website. Instead, it refers to the difficulty that some individuals have in finding doctors, hospitals and other healthcare providers who accept their insurance plan. In fact, sometimes you may find yourself dealing with an out-of-network medical provider and not even know it! The best way to avoid this is to make sure your doctor accepts your specific type of health plan, or vice versa. If you are unsure about what type of health plan you have through work, you should ask your employer for the full details.
Understanding the benefits of your health plan will help you make the best decision for your specific needs. Make sure that whoever you are dealing with -- whether it is an administrator at work, your doctor or a medical facility -- understands which type of health plan you have so that everyone is working from the same information.
Using an online search engine like Google, you can find many providers who offer quotes and recommendations on individual health insurance plans. The best part about purchasing insurance online is that it is quick and easy to use. You only have to enter a few basic details such as your age, address and income level and then the sites will present you with several different plans to choose from.
Conclusion
Researching insurance options can be a bit confusing. The information above should help you to understand the basics of PPOs and individual health insurance plans, including the differences between them. After you have made your decision, you may want to take some time to decide which type of policy will suit your needs best. If you have any questions or concerns, make sure that you speak with a licensed agent or financial advisor who can provide additional expertise and information. You should not feel pressured or rushed. Choose a policy that is in line with your budget and your expectations for the future.