What You Must Know To Get The Best Health Insurance For Your Money
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What is the truth about health insurance? Is it possible to find low cost health insurance? The truth about finding low cost health insurance really depends on your understanding of a few key basics. Many people think that health insurance is all the same, but that is not true and making that mistake can cost you money. In this article I will try to help you understand some of the key concepts underlying present day health insurance.
One of the first things to understand is that when you purchase health insurance, just as with any kind of insurance, you are purchasing a sort of contract that guarantees you a specific set of benefits. In order to remain eligible to receive those benefits, you pay a recurring, monthly fee which is called a premium. The premium is the insurance company’s fee for managing the risk of your need for health insurance coverage. At bottom, all insurance is risk management, and you are essentially paying the insurer to assume the risk of payment for health care.
Health insurance comes in many different forms. For example, there is disease insurance, accidental death and dismemberment insurance, catastrophic health coverage, COBRA insurance, and maternity coverage to name just a few examples. All of these, by the way, are kinds of health insurance. When you shop for health insurance you are generally presented with a variety of plans that offer different benefits and different levels of coverage. Insurance plans are the way the insurance is packaged. The plan is the “bottle” holding the wine, as it were.
Some of the kinds of insurance plans most commonly sold are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee for service plans (PFFSs). The HMO, PPO, and PFFS are different ways of packaging benefits. That means that each kind of plan will pay for different kinds of services and each plan will have different payment rates. A payment rate is how much they will pay health care providers for their services. HMOs are usually less expensive but generally require you to get all of your care only from providers in the plan’s pre-determined network of doctors and hospitals. In an HMO you would be assigned a Primary Care physician, and a referral from that doctor would be required in order to see a specialist. Quite often, HMOs work better for individuals who in relatively good health and whose medical needs are not terribly demanding.
PPOs generally offer greater flexibility of coverage than HMOs. Whereas HMOs require that you receive care only from network providers, PPOs allow you to go out-of-network and do not require referrals. PPOs also include network providers (doctors and hospitals who have a contract to provide care to plan members), and care within the network will always be less expensive than going out-of-network. PPOs are often more expensive than HMOs but are generally considered to offer more coverage. You can see that if you understand you and your family’s needs, you can determine whether a less expensive HMO or the more expensive PPO would be appropriate. Even though a PPO may be more expensive, if it more adequately meets your needs, it may less expensive in the long run. Some examples of the big health insurance names you may encounter include United Health Care, Humana, Blue Cross, Blue Shield, Aetna, Cigna, Anthem, Tonik, Wellmark, and John Deere.
Another common sort of managed care plan is the private fee for service plan (PFFS). The PFFS has no pre-established network of doctors and hospitals and leaves your choice of provider up to you. It is important, therefore, that your doctors agree to accept the plan’s payment terms, and that you find out before you receive services if you doctors submit claims to the insurance company. Rather than offering you a fixed package of benefits, as is the case in an HMO or PPO, your providers bill the PFFS a fee for each service you receive, and the PFFS pays for each service according to its fee schedule, or payment rate.
When you buy a health insurance plan, the actual cost of the plan is not only the price of the premiums, deductibles, co-pays and co-insurances. When you figure the real cost, you must also take into consideration the reliability of the company in living up to their promise of coverage for the kinds of services that are important for you and your family. Thus, a “cheap” plan could end up costing you more if the company doesn’t cover the costs specified in the policy. Humana, for example, may offer you less expensive plans, but if you have to argue with them over meeting the basic agreements in the policy, then the coverage would be useless and the cost to you far greater than you had imagined.
You can find cheap quotes for health insurance, but the key to a low cost plan is in coming as close as you can to paying only for a relatively few number of key services. In other words, if possible, you strip the policy of every service you can possibly do away with and assume as high a deductible as possible. Also, you must verify the reliability of the company because it’s important that they pay promptly and without argument should a time of need arise.
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