Personal health insurance is necessary.

No matter if you’re insured by your employer, a personal insurance policy is always better than a plan.

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What is Health Insurance?

Health Insurance is the assurance of financial support by the Insurance Company, in case if you got some health problems. It covers illness, fatal injuries, hazardous disease, accidents, surgeries or operation expenses, and sometimes even dental expenses too. 

Health Insurance is a commitment to yourself by you placing your health at priority. You need to pay a small amount while insuring your health as premium money. This premium amount works as the safety of your savings from medical bills. Most of the Insurance companies have a tie-up with the hospitals and doctors. When you are insured, they pay the larger portion of your medical bills directly to hospitals. Some Insurance companies also provide the facility of reimbursement for their customers (first pay then claim policy). 

What is public health insurance?

This is the health insurance done by federal or state governments of the U.S. and all the medical expenses are bearded by them. They provide two types of health insurance to their citizens. First is Medicare and second is Medicaid. Medicare category is established for senior citizens above 65 years old and the person with certain exceptional disabilities. On the other hand, Medicaid is for low-income people or the person with common disabilities. In the U.S.A, 35% of the health insurer is insured with public health insurance.

What is private health insurance?

When you go and purchase health insurance for you or your family on your own, this is called private health insurance. The private entity takes responsibility for the payment of your medical expenses. The medical contract is made between you and the private insurance firm without any intervention of the federal government. Over 65% of health insurer takes insurance service from private health insurance.

What is group health insurance?

The persons who are doing jobs, get a group health insurance plan mandatory by their employers. A part of the health premium is paid by your employer in this case and sometimes the employer wishes to pay the whole premium amount. The group health insurance has the benefits that meet the essential coverage requirement of the affordable care act.

The evaluating risk of insurance company gets distributed among the group members because of which subscriber gets premium at a reduced rate. Just understand you are sacrificing a little amount of money for a long term financial safety in the situation of medical bankruptcy.  In the USA, the affordable care act is raising awareness about the importance of Health Insurance and helping people a lot. They had put a capping over the own pocket expenses in the medical bill which is $6600 for individual and $13200 for a family.

Why do you need Health Insurance?

Health Insurance is important because the illness is unpredictable and costs a lot to treat. Also, it is often impossible to avoid or postpone it until you get a more convenient moment. Low-income people need much medical attention after retirement. So, Health Insurance is a valuable product one should get. Moreover, in America it is non-taxable. So be stress-free while receiving medical treatment. Your insurer is going to pay a large part of your clinic, hospital, doctor, pharmacy, and laboratory fees.

This corona-virus pandemic has certainly taught us the importance of making a prior arrangement of money for a medical emergency. So, not becoming ignorant – buy your health insurance from us. Health is Wealth; if health is gone – your life is almost nil. Protecting your health pre & post disease should be given the utmost priority. But still, people live in the illusion that nothing can happen to their health and are not prepared financially for medical cases. The possibility of getting empty of pocket without health insurance is much high.

Different Types of Health Insurance

Health Insurance is a broad term and it’s not as simple that you go and purchase the Insurance without understanding the types. In the USA different health care plan models are used. Get familiar with these plans and their unique features. It will help you in choosing the one according to your budget along with medical care facilities. 

1. HMO (Health Maintenance Organization): 

This is a typical and mostly purchased health insurance plan. Many doctors and health care providers do contract with the organization to see the patient. Through this network of doctors and clinic- HMO charges premium amount as an insurance per month. It allows you to pay a flat fee for a visit which is usually $5,$10 etc for a check-up. Other expenses are born by HMO.

Pros:

  • Not much paperwork is involved.
  • Primary doctor manages and co-ordinates your medical care.
  • Easily affordable than PPO and No deductible, annual checkups are free.
  • Have to pay a small premium per month to avail easy flat fee for every visit within HMO doctor’s network.

Cons:

  • Out of network HMO hospital expenses is not covered. You may have to pay from your pocket.
  • Referral from a primary physician is mandatory to visit specialists.
  • Very less freedom to choose your favourite health care provider.

2. PPO (Preferred Provider Organization) plan: 

This is a health care plan in which the insurance is done at reduced rates. Like HMO, it also has a network of doctors and health care providers. Subscribed clients can visit the preferred doctor of their choice within the network of PPO. PPO plans have two deductible one for in the network and other for out of network. Generally, out of network costs you more and you have to pay high too.

Pros:

  • Unlike HMO where subscriber had no option rather than taking service from the assigned provider, PPO gives the freedom of choice of health care providers.
  • Referral from a primary doctor is not mandatory to visit a specialist one.

Cons:

  • Comparatively high premium than HMO.
  • Two annual deductibles if you choose out of network facility also.

3. EPO (Exclusive Provider Organization): 

This health care plan provides moderate freedom to choose health service. It has a network of clinics, doctors and health care facilities centre. You have to co-pay a flat fee of $10 around for a visit.

Pros:

  • Monthly Premium is usually low than PPO.
  • One can visit specialities doctor directly without the referral of a physician.
  • Little to not much paperwork involved. 

Cons:

  • Provide health care and hospital services within their network only. You have to pay in full from your pocket in an emergency for out of network doctors.
  • Some EPOs have a high deductible.

4. POS (Point of Service plan):

This plan provides all the facilities what an HMO and PPO provide. In other words, this is just the integrity of HMO and PPO. It provides more freedom to choose your health care provider. In case of out of network service, you may have to pay first from your pocket and later reimburse it by submitting bills.

Pros:

  • It provides in and out both of the network health service provider.
  • Provides the freedom to choose a health provider.
  • Do not have deductibles.

Cons:

  • Premiums are comparatively high than HMO and PPO.
  • Hectic Paper works involved in case of out of network service.

5. HDHP (High deductible health plan):

This is a highly deductible health plan. The deductible is the capping amount that one has to pay from own pocket before claiming the extra surcharge from the insurance company. The deductible amount varies in the range of about $1400 for an individual to $2700 for family. It means if the bill is above $1400 for individuals, the extra amount is paid by the insurance company. 

Pros:

  • Very less premium than all other health plans.
  • Good for one who is less susceptible to health problems and remains most of the time healthy.

Cons:

  • Higher deductibles, most of the time if the medical bill remains below the annual deductible amount then you would not experience financial benefits.
  • The paperwork involved in the process. 

What is covered in Health Insurance?

In general, health insurance covers all types of illnesses and major health problems. But the depth of coverage has also been decided by the Insurance companies. The health insurance companies face a more fundamental task. If they don’t calculate with certain accuracy that how much a customer can claim, definitely it will go under debt and burden of claims.

Insurance companies bring medical packages describing the various benefits and costs of tests, laboratories, pharmacies drugs covered therein. Before purchasing insurance you need to check the essential coverages. To clarify the coverings under Health Insurance, companies have divided the health insurance into four tiers. Bronze, Silver, Gold, and Platinum with different covering features in all.

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Proportionally, the more you pay premium more coverings and benefits you would get and vice-versa.

The major fearful portion of medical cases like operation, surgeries, ventilation, ICU, hospital admission is covered in health insurance packages.

How much is Health Insurance?

The premium and deductible prices are not fixed and it varies according to the circumstances. The prices are different for different persons which are based on various aspects. The insurance companies will, of course, try to repair the health insurance market by finding out more information about their customers. They will check the following before deciding the premium and deductible price:

  • Whether the customer smokes?
  • Age of the customer
  • Genetic history of any disease in their parents
  • Health condition of the customer before health insurance.

In general, the premium goes between $330-$750 range based on the calculated risk factors from the side of the insurance company. The price also varies location wise and there is a possibility of a hike in prices.

How does Health Insurance work?

These four things one should consider before understanding how health insurance works.

  • Premium amount: This is the amount you are charged monthly by the insurance company. You are giving this to manage financially the risk associated with your health.
  • Annual Deductible amount: This is the capping amount you have to pay before insurance starts paying the extra charge of your bill.
  • Co-insurance: This charge is associated with the insurance which is a few percentages of your total cost subject to maximum capping amount of the deductible.
  • Co-payment: This is generally a very low flat fee that you pay to the doctor for taking the appointment.

Let us understand it with an example for more clarification on how health insurance works:-

Suppose, Yearly deductible amount = $5000

          Co-insurance= 10%

          Yearly out of pocket maximum= $6000

For some time, The company is neglecting the monthly premium amount (which you have to pay regular monthly anyhow surely.)

Let’s say the medical bill is $50000, for in the network health service provider.

First, you have to pay the deductible amount $5000 after then 10% of the entire medical bill i.e, $5000. But the entire out of pocket maximum is capped at $6000. So, instead of $10000, You are supposed to pay only $6000. 

The rest amount of $50000- $6000= $44000 will be paid up by your insurance company. This is certainly a good innovation for the persons of America who are much dependent on health insurance.

What Health Insurance is best for you?

This is a very critical question that one cannot answer it in general. It is based on the condition in which a person is bounded. If you are sensitive to premium payment and if it is hampering your monthly income, better you should choose a plan with high deductibles with less premium.

You need to check whether more clinics, doctor, and hospitals are included in their network areas. You need to check whether your health plan covers the medical need. You should choose one that allows all types of reimbursement to pharmaceutical drugs, tests, doctor’s fees in a very easy process.

After all, every health care plan has its pros and cons. Let us help you find the best one for you.

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