Guide to Insurance

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What Is The Health Insurance

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Like other forms of insurance, you don't need health insurance until you NEED it. Automobile insurance doesn't help until you get into a car accident. Life insurance isn't of value until you die. And health insurance doesn't do you any good until you need medical assistance. But, if you believe in Murphy's Law -- that whatever can go wrong will go wrong -- then you should consider getting health insurance.



Health insurance coverage varies greatly between policies, but basically, it pays a pre-negotiated percentage of the expenses for a policy holder's covered medical treatments.

3 Types of Health Insurance

In the United States, there are 3 basic types of health insurance:

1. Self-Insured/Uninsured. People with no insurance,and people who have health insurance but are responsible for paying 100% of the insurance premium. This group is estimated at 30% of the US population.

Managed Care Plans. They fall into 3 categories. All are essentially networks offering services from specific providers at contracted prices:

* Health Maintenance Organizations (HMO) are plans in which members pay a fixed monthly fee, regardless of how much medical care they need in a given month. HMOs provide medical services ranging from office visits to hospitalization and surgery, and usually require that you stay within the network when you need services from physicians and hospitals.

* Preferred Provider Organizations (PPO) are groups of doctors and hospitals that provide medical services only to members. PPO members typically pay for services as they are provided, and the PPO sponsor reimburses them for the cost of the treatment. In most cases, the healthcare providers and the PPO sponsor negotiate the price for each type of service in advance.

* Point of Service (POS) plans are less common than the other 2. Here you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside of the network for healthcare, you will be subject to excess charges or deductibles.

3. Indemnity Plans allow participants to seek medical assistance whenever and wherever they need it. Participants can visit any doctor or specialist, as often as they feel necessary. There are no restrictions when it comes to seeking medical help. This is by far the most expensive type of health insurance plan.

Which of these types of health insurance is best for you will depend on your personal situation. Choosing a health insurance plan is a time-consuming task, but an educated choice will ensure you have the right insurance coverage when the need arises. And as we age, the need will inevitably arise.
What Is The Health Insurance
So your employer in Dallas, Houston or any place in Texas doesn't offer health insurance. Perhaps you can't afford to pay for a health plan. Or maybe you just don't want pay for health coverage because you're healthy enough that you feel "you don't need it." If you fall into any of these categories, you may be a candidate for a "catastrophic" health insurance plan, or what is sometimes called a "high deductible" health plan (HDHP).

Catastrophic health insurance is usually characterized by its high deductibles and low monthly premiums. These plans typically cover major hospital and medical expenses only above a certain deductible. This means you are likely to pay out-of-pocket for most everything else, like routine doctor visits and many, if not all, prescription drugs.

The many catastrophic health insurance plans offered these days cover expenses for hospital stays, surgery, intensive care, diagnostic X-ray and lab tests.

When choosing this kind of plan, your deductible may start at $1,000 a month or higher. Along with the high deductibles, many catastrophic health plans have high lifetime maximum benefit payments, or caps, which can be between $1 million and $5 million. Once you reach your cap, the insurance company won't pay for any additional medical expenses and your coverage is terminated.

By selecting a high-deductible plan, it's expected you'll pay for your medical needs until your expenses exceed your deductible. For example, with a $15,000 deductible and surgery that costs $5,000, you would pay for the surgery entirely. You should also be aware that the deductible limit for a high-deductible health plan, which is qualified as a Health Savings Account (HSA) is $5,000 in 2007 (unless you are age 55 or older).

If you decide to pursue a catastrophic health insurance plan, you should also know that most of them do not cover most of the costs of pregnancy care. So if pregnancy is a possibility, make sure to check if pregnancy coverage is available with your plan. Some catastrophic plans don't cover maternity care for a full year after your effective date.

People who buy catastrophic health insurance tend to fall into two groups: young adults in their 20's and older adults ages 50 to 65. Young adults who buy catastrophic coverage are usually self-employed or have no coverage through their employers.

Older adults who buy this kind of policy are concerned with financial losses associated with heart attacks, cancer or other serious illnesses. They're generally healthy, have very few or no prescriptions, and would prefer to pay out of pocket for office visits to save on premiums.

Catastrophic health plans can be purchased as an individual health insurance plan, as well as through employer group plans. Companies with 1,000 or more employees typically offer higher deductible plan options. Retirees, who aren't yet eligible for Medicare, also often choose catastrophic plans to reduce their premiums.

Certain pre-existing conditions will make you ineligible for a catastrophic health plan in the individual health plan market. Health conditions such as AIDS, diabetes, emphysema, heart disease, multiple sclerosis, and schizophrenia, as well as some other serious illness, are red flags to insurances companies and can prevent you from being underwritten for a catastrophic plan. While serious impairments like these will disqualify someone from a high- deductible plan, that it is much easier for someone with mild impairments to get a high deductible plan - particularly the very high deductible plans - than a low deductible plan.

Like many other health insurance plans, you can purchase different levels of catastrophic coverage depending on what type of high-deductible plan is chosen.

Before purchasing a catastrophic health plan, you need to consider:

How much is the premium, and do you pay monthly, quarterly, annually?

How much is the deductible?

How much of a deductible can you afford?

How extensive is the coverage?

Do you need prescription medications?

Are your own doctor's office visits affordable?

Do you have any pre-existing conditions?

Do you get sick often?

What's the annual and lifetime coverage limit?
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About Author
Both Ron King & Pat Carpenter 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.

Ron King has sinced written about articles on various topics from Acne Treatment, A Secured Loan and Aging. . Ron King's top article generates over 368000 views. to your Favourites.

Pat Carpenter has sinced written about articles on various topics from Women, Marathon Tips and Insurance. Pat Carpenter writes for Precedent Insurance Company. Precedent puts a new spin on health insurance. Learn more at . Pat Carpenter's top article generates over 823000 views. to your Favourites.
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