Today more than ever before, health insurance coverage is essential in providing your family with the health security they need should anything happen. Generally, good health insurance coverage will include medication, consultations with doctors, hospitalization and hospital stays. Some health insurance coverage may also include diagnostic and treatment procedures.
There are several basic health insurance coverage plans to consider. In a managed care plan the insurance company offers its own doctors and hospital affiliations. The disadvantage of managed care health insurance coverage is that you're often required to pay an additional fee should you prefer to visit your own doctor or be admitted to the hospital of your choice.
A Fee-of-Service plan is a health insurance coverage plan in which the company splits the cost of the doctors and hospital bills with the insured. The insured pays the insurance company a monthly premium, while the insurance company pays a portion of doctor and hospital expenses. Fee-of-service plans provide either basic coverage or major medical coverage. A basic fee-of-service plan covers the hospital room and hospital care, plus some additional hospital services such as x-rays and medications. Basic coverage also includes the cost of surgery and some doctor visits. A major medical fee-of-service plan is designed to cover the cost of long term care and major illness.
Next is the Health Maintenance Organization plan, commonly referred to as an HMO. Services, such as doctor's visits, hospital stays, surgery, diagnostic tests, etc., are fulfilled by providers under contract with the HMO. The insured, therefore, generally does not have the freedom to choose his or her own doctors or hospital. Typically, the insured is assigned to a primary care provider and must go through this provider in order to be referred to other doctors or specialists (who are also contracted with the HMO in most cases) when necessary.
Medicare is a national health insurance program for people 65 years of age and older, certain younger disabled people, and people with permanent kidney failure. Medicare is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Part A helps pay for care in a hospital and a skilled nursing facility, and for home health and hospice care. Part B helps pay doctor bills, and for outpatient hospital care and other medical services not covered by Part A. You do not have to pay a monthly premium for Part A if you or your spouse worked for at least 10 years in Medicare covered employment, and you are 65 years old and a citizen or permanent resident of the United States. Everyone who enrolls in Medicare Part B must pay a premium.
COBRA isn't a health insurance plan, but a government effort to protect people from losing their health benefits in certain situations. Passed in 1986, the Consolidated Omnibus Budget Reconciliation Act (COBRA) requires most group health plans to provide a temporary continuation of group health coverage that might otherwise be terminated. Situations that are covered by COBRA include the death of a covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, divorce, or legal separation from a covered employee, a covered employee’s becoming entitled to Medicare, and a child’s loss of dependent status (and therefore coverage) under the plan. COBRA generally applies to all group health plans maintained by private-sector employers (with at least 20 employees) or by state and local governments. The law does not apply to plans sponsored by the Federal government or by churches and certain church-related organizations.
There are a wide variety of health insurance coverage plans available to most people. A little research and working with either your employer or insurance agent will help you find the perfect plan for you and your family.
Health Insurance Prescription Coverage
Health Insurance Coverage: What are ?Covered? Services?
Health insurance coverage is a contract used to determine medical benefits that are covered, or not covered, between you and your insurance provider. The insurance company, based on a fee that you provide them on a regular basis, promises to pay health insurance coverage on certain items or benefits listed in that contract. These are called ?covered? services. ?Covered? services can include a wide variety of things, such as implements, prescriptions, services (such as massage), checkups, tests and/or research.
Your contract should also list all of the things NOT covered in your health insurance coverage ? these are items or services that you will need to pay for out of your own pocket, should you require them.
Health Insurance Coverage: What is a Medical Necessity? How is this Different from Covered Services?
Just as it seems, a medical necessity is something that your health professional has deemed a required service/ item that will affect your health negatively should you decide not to purchase it. However, just because your doctor tells you something is a medical necessity does not mean your health insurance actually offers coverage for it.
Since insurance companies decide what health coverage they will and will not provide, you really have no leeway in this area.
Health Insurance Coverage: What Do I Do?
Most doctors try and keep themselves abreast as to what the major insurance companies do, and do not cover when it comes to health coverage. However, there are a LOT of plans out there, so this just isn't enough. So how can you avoid any nasty surprises during an emergency?
Read your health insurance coverage. You're better off knowing what your health insurance company will, and will not provide coverage for right off the bat. Then, if your doctor decides on a treatment plan that isn't covered, you can ask for alternatives that may be.
If there are questions regarding your health insurance coverage, do not hesitate to contact the insurance company. Questions are good, and they expect them.
Health Insurance Coverage: What Do I Do if Something I Need Isn't Covered?
The gross majority of what your doctor orders for you will be covered in your health insurance plan. If you do get a treatment or supply that isn't covered, you can always challenge the health insurance coverage. You may not be the only one who requires the same type of service, benefit or item ? so you'll end up fighting not just for yourself, but for others in the same situation.
Ask your doctor for their side, and use this in your claim. It may not help in the end, but if your doctor is on your side, you may be able to convince the health insurance company that coverage is required.
Both David Silva & Peter Lenkefi are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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