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Understanding Health Insurance Coverage Options
Many terms are used when describing the large number of available types of health insurance plans. In order to better understand the plans you are comparing, knowing some of the definitions of the words that are usually not seen in other places is essential. Here are some important words and terms to understand:
- Deductible: A deductible is the amount of money you must pay out-of-pocket before coverage by your insurance provider kicks in. Generally speaking, the lower a premium is, the higher the deductible is.
- Premium: This is the amount that policyholders pay their insurance company for health coverage each month. It can also be used to refer to the total amount paid over the course of a policy.
- Out-of-pocket: This is the amount of money that a policyholder pays, before insurance kicks in. Unlike a deductible, which can be on a per situation basis, this is a general blanket term for money the policyholder pays.
- Out-of-pocket maximum: This is the most money that will come from a policyholder's payments before an insurance company will begin to pay for all covered expenses.
- Coinsurance: Coinsurance is the amount of money that is owed to a medical provider after the deductible has been paid. It is often a predetermined percentage of the total bill given.
- Co-pay: Similar to coinsurance, it is different in the sense that a co-pay is made at the time of service. These are usually standardized, being the same for each type of service a co-pay exists for.
- In-network: This is a term that is used to describe healthcare providers and medical establishments that have agreed to work with an insurance company at discounted rates.
- Out-of-network: This is a blanket term that is used to describe medical professionals and healthcare establishments that are not considered in-network.
- Referral: A referral is a notice from a qualified physician that recommends treatment from specialists for the policyholder.
Types Of Health Insurance Providers Available
There are a number of different plan structures that are available for people who are seeking health insurance policies. While it can be confusing, there are a few specific differences between each type of plan that is available.
HMO: A Health Maintenance Organization, or HMO, requires policyholders to select a primary care physician. This physician is the first stop when the policyholder receives care. They coordinate treatment and provide required referrals for specialist care services. Visiting physicians or specialists outside of the HMO network can result in having to pay all of the expenses out of pocket. This is a popular plan, and one that is recommended for people who do not have pre-existing conditions that require medical professionals who are not the primary care physician.
EPO: An Exclusive Provider Organization is similar to an HMO, but a primary care physician is not required. Policyholders are able to use any in-network physicians and specialists at lower costs. If they choose to go out of network, the results in most cases are higher out-of-pocket costs. Recommendations from a primary care physician are not required.
PPO: This type of plan is the same as an EPO plan, but with one major difference. When visiting out-of-network professionals, PPOs cover the visits at a higher frequency. PPOs do not require out-of-network service providers at all. A PPO plan is often recommended to people who visit specialists and physicians that are out-of-network.
POS: Point of Service Plans are plans that require a primary care physician, and the primary care physician must make referrals for policyholders to see other physicians or specialists. The out-of-pocket expenses for this type of plan are often higher, but visits to out-of-network medical professionals are still covered in some regards.
HSA: A Health Savings Account can benefit people who have a high deductible on their insurance plan. It is on account that is used to save money for future medical expenses, and the funds distributed from them are not taxed.
Types Of Plans In The Affordable Care Act
- Bronze: The policyholder pays 40% coinsurance, and the insurance provider pays 60%.
- Silver: The policyholder pays 30% coinsurance, and the insurance provider pays 70%.
- Gold: The policyholder pays 20% coinsurance, and the insurance provider pays 80%.
- Platinum: The policyholder pays 10% coinsurance, and the insurance provider pays 90%.
Catastrophic: Catastrophic health insurance works a little bit differently in that it is generally available only to women and men who are under the age of 30 or qualify for a hardship exemption. Without meeting these criteria, a catastrophic health insurance plan is not available.
Each plan has its benefits, with gold and platinum plans often being the best for people who need to see the doctor more often. Bronze and silver plans are usually better for people who are considered healthy and do not visit the doctor very much. Enrollment in these plans can happen during an open enrollment period. Enrollment can also occur if a person experiences a qualifying life event such as the loss of health coverage, having a child, getting married, a death in the family, changes of residence, and other qualifying events such as changes in income and becoming a United States citizen.
People who are seeking healthcare coverage do not have to utilize an Affordable Care Act Healthcare Exchange if they do not want to. They can instead choose to purchase an insurance plan from a provider not listed on the official exchange.
Top 10 Health Insurance Providers
Choosing a health insurance provider is not always easy. Each company provides access to different plans, different rates, and various exclusions. The health insurance plan that people select is often due to their unique circumstances and the location that they live. Customer service satisfaction is highly important, as is the quality and inclusions in each plan. Some of the highest-ranking companies for health insurance include Blue Cross/Blue Shield, Humana, Kaiser Permanente, AETNA, and United Healthcare. These companies are consistently ranked in the top five health insurance companies. Other top 10 companies include United Healthcare, CIGNA, Molina Healthcare, Assurant Health, and AFLAC.
Not every healthcare company provides policies in every state. Due to this, an insurance agent from American Insurance can help direct you to the best companies available near you, as well as the best policies. Keep in mind that not all companies and plans have listings on the Affordable Care Act Exchange. Comparison shopping for all available policies is best done through an American Insurance agent.