Guide to Insurance

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Health Insurance Plans Individuals

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For most of us, a primary consideration when choosing a health care plan is the cost. Coverage is important, but with the rapidly increasing cost of healthcare, finding the right health insurance plan for your budget is job 1. Knowing what you need in a health insurance plan, and just who and what needs to be covered by it, will help you to decide what type of policy you need.



Health Care Plans For The Individual

An individual health insurance plan covers only you. No surprise there. If you have no dependents, this will be the best choice from a cost standpoint. Individual plans still vary a great deal in price, depending on the type of coverage you choose.

The Indemnity Plan.

A traditional health insurance plan that covers visits to any doctor you wish to see, and will cover any procedure the doctor prescribes for you. You'll notice variations between plans as to the size of the deductible and the limit on out-of-pocket expenses. Overall, this is the more expensive type of individual health insurance plan, but it offers the most freedom of choice.

The Managed Plan.

Individual managed plans, like HMO's, are more cost-effective, but you give up some of the freedom of the indemnity plan. You will be able to see only the doctors on your approved list, and any specialists you see must be by referral. If your health care amounts primarily to yearly check-ups and the occasional prescription for antibiotics, this is a plan that could work for you. It will cover health emergencies, there are just more hoops you have to jump through.

Both of these health insurance plans sometimes include prescription and dental coverage at an additional cost.

Family Health Insurance Plans

Since family health insurance plans cover more than 1 person, the cost will naturally be higher. The bigger the family, the bigger the price tag. Also, the age, gender, and health choices (like smoking) of each family member will play a big part in how much this type of policy will cost. There are indemnity plans for families and they offer the same freedoms as the individual plans. This can be a real bonus when dealing with multiple people on 1 policy.

Family health insurance plans also come in the managed health care package and work pretty much the same way as the individual ones. The cost will be higher than the individual managed plan, but not as high as the family indemnity plan.

Group Insurance Plans

Many companies now offer their employees group insurance coverage, footing the bill for most or some of the premium. Since many of these companies offer both types of health insurance coverage, how much you end up paying out-of-pocket will depend on which type of policy you choose.
Health Insurance Plans Individuals
What do you really need to know when deciding which health insurance plan is appropriate for you? While the information is most times segmented into individual, family or group coverage, there are many other factors that impact your insurance selection. Selecting the wrong plan can leave you under-insured and resulting in catastrophic loss when hit with a major medical issue. Review these 10 areas to know what to look for in your health insurance plan.

1) Prescription drug coverage – Depending upon the type of insurance plan you select, you will want to know if you will be adequately covered. Especially if you are already taking prescription medication on a regular basis, you will want to know which drugs are covered. In most cases, you will want a plan which includes co-pays and includes the ability to choose between generic or brand name. If you are prescribed a newer or experimental drug, you will need to do some research as many companies won't cover these costs.

2) Preventive services costs – these include services like annual exams, tests and screening including routine immunizations. Many times services like these are also on a co-pay system. Besides knowing what type of service is covered, you'll also want to know how much you'll have to pay.

3) Office visits – these include visits that are not covered under preventive services. One thing you'll want to find out is if you'll be able to use your regular doctors. If you currently use an HMO, you may only have the choice of participating providers. If you are using a PPO, you are normally free to consult with any doctor. In most cases, you can check to see if your doctor is covered under your plan before you buy.

4) Imaging and laboratory services – these include testing and interpretation of results for services like CAT scans, MRIs and x-rays. Many plans include a discount program where you get these services at a discount rate when used by an independent company such as Lab One.

5) Outpatient services – these include in-and-out services that do not typically require a hospital stay. They cover facility costs and the costs of supplies that you would need during your treatment.

6) Emergency room services – these include the use of services and supplies for the emergency room. This may or may not include ambulance services and supplies. Most plans charge an access fee to use the emergency room unless you are admitted.

7) Health care practitioner services – these include the services of a specialist such as surgeons, anesthesiologists, assistants and nurses. Besides costs, you'll also want to know how easy it will be to see a specialist. Will you have the flexibility of choosing a doctor on your own or will you need to have a referral

8) Outpatient physical medicine – these include things like physical, speech and occupational therapies as well as rehabilitation services including chiropractic care.

9) Inpatient hospital – these include the use of hospital care – room and services as well as supplies and equipment.

10) Other services – these vary greatly from plan to plan and carrier to carrier. These services may include dental, vision, other specialized care and surgery, behavioral health and substance abuse and home care.

One other major factor that wasn't mentioned earlier was that of the overall plan costs. These costs include annual premiums, umbrella deductibles as well as embedded deductibles. When planning for your annual medical expenses, you'll need to estimate the cost of your premiums as well as any co-pays or non-covered payments that you might have to make. In addition, you'll also need to keep track of the umbrella and embedded deductibles to make sure you still have adequate coverage throughout the year.

Review these 10 areas to insure you properly review your health plan coverage. You'll also want to review your plan at least annually to ensure it provides what you need.
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