Today, there are some 40+ million Americans without medical insurance. Apart from rising health costs, the reason that figure is so high, is that many businesses, which used to provide a variety of health insurance, no longer offer it. And for the businesses that still do provide it, employees are expected to pay for most or all of the cost. So, what do you do if your employer does not offer medical insurance, or you are self-employed?
There are three basic types of health insurance: fee-for-service, PPO, and HMO. Most insurance companies either offer a noncancellable policy (also known as a guaranteed renewable policy), under which the coverage cannot be canceled as long as premiums are paid (though rates can be increased), or a conditionally renewable policy, which cannot be canceled on an individual basis, though canceled on a class basis. The former is obviously better than the latter, but will probably cost more.
The fee-for-service policy is the more traditional type, which allows complete freedom in selecting physicians and hospitals for services. It’s also by far the most expensive. Most policies will also have deductibles--you have to meet a minimum expense before the insurance will kick in—of the order of $250-500 per family, or person, depending on whether it is a family or individual type of plan. In addition, there are caps, or maximum amounts that the insurance company will pay for certain procedures. Some procedures are not covered at all, so be sure to read the policy thoroughly! Also note that for most procedures and services, the insurance will pay around 20% of the cost, with the insurance company picking up the remainder. Shop around to obtain the best prices.
The PPO type of plan, or Preferred Provider Organization plan, restricts the number of physicians, or hospitals or clinics the insured can use in a given geographic area in order to be reimbursed. When the insured uses “out-of-network” doctors or facilities, the costs of visits that can be reimbursed will drop considerably.
The HMO type of plan, also know as Health Maintenance Organization, was an attempt originally to cap costs, and make medical insurance plans more affordable. The idea was for the insured to select a primary physician from a list, and then be referred to a facility or specialist for non-routine care after first seeing the primary care physician. Unfortunately, many for-profit organizations abused the system, and patients complained bitterly about the restrictions. Today’s HMOs are more caring, but the many of the original criticisms still stand.
Probably the most important advice is to make a list of your health priorities, decide what you are willing to pay, and browse the links above not only for plans and costs, but whether the physicians and hospitals in your area that are available under the plan, meet your needs.
There are three basic types of health insurance: fee-for-service, PPO, and HMO. Most insurance companies either offer a noncancellable policy (also known as a guaranteed renewable policy), under which the coverage cannot be canceled as long as premiums are paid (though rates can be increased), or a conditionally renewable policy, which cannot be canceled on an individual basis, though canceled on a class basis. The former is obviously better than the latter, but will probably cost more.
The fee-for-service policy is the more traditional type, which allows complete freedom in selecting physicians and hospitals for services. It’s also by far the most expensive. Most policies will also have deductibles--you have to meet a minimum expense before the insurance will kick in—of the order of $250-500 per family, or person, depending on whether it is a family or individual type of plan. In addition, there are caps, or maximum amounts that the insurance company will pay for certain procedures. Some procedures are not covered at all, so be sure to read the policy thoroughly! Also note that for most procedures and services, the insurance will pay around 20% of the cost, with the insurance company picking up the remainder. Shop around to obtain the best prices.
The PPO type of plan, or Preferred Provider Organization plan, restricts the number of physicians, or hospitals or clinics the insured can use in a given geographic area in order to be reimbursed. When the insured uses “out-of-network” doctors or facilities, the costs of visits that can be reimbursed will drop considerably.
The HMO type of plan, also know as Health Maintenance Organization, was an attempt originally to cap costs, and make medical insurance plans more affordable. The idea was for the insured to select a primary physician from a list, and then be referred to a facility or specialist for non-routine care after first seeing the primary care physician. Unfortunately, many for-profit organizations abused the system, and patients complained bitterly about the restrictions. Today’s HMOs are more caring, but the many of the original criticisms still stand.
Probably the most important advice is to make a list of your health priorities, decide what you are willing to pay, and browse the links above not only for plans and costs, but whether the physicians and hospitals in your area that are available under the plan, meet your needs.
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