What are you buying when you purchase health insurance, and how do you know if you are getting a good deal? The answers to these questions depend on your understanding a few basic health insurance concepts. Don’t worry, these are easy to grasp and well worth the time when you start shopping for the best, low cost health insurance. The point of this article is to help guide you through these basics so that you better understand what you are getting when you buy a health insurance plan.
When you buy health insurance, just as with any insurance, you are paying the company a monthly fee (insurance premium) to manage the risk of your need for health care coverage. The more risk the company assumes, the greater the premium. However, you as a consumer must understand what you are paying for, and you also have to be your own watchdog to some degree and pay attention that you get what you pay for. At its basic level, health insurance is the assumption of risk on the part of the company.
When you start looking for health insurance, you quickly find that there are many different kinds of plans and ways in which the insurance benefits are packaged. For example, you may not know that you can purchase health insurance to cover you in case of dismemberment on the job, or insurance to cover you for specific kinds of hospital care. Maternity coverage would be another example of a kind of health insurance. Most people, however, think of health insurance in terms of doctor visits, hospital care, and emergency services. Finding the best low cost insurance for you means that you must think about which benefits are most important for you. When you start your insurance shopping, knowing what you need will help you choose from the packages offered by the many insurance companies.
Examples of different kinds of insurance plans offering different packages of benefits would include the health maintenance organization (HMO), preferred provider organization (PPO), and private fee for service plan (PFFS). An HMO is a kind of plan that includes a set menu of benefits, and your coverage–or health care–would be provided by doctors and hospitals in the plan’s network. By network, I mean those providers who have an agreement to offer care to the plan’s members. An HMO would assign you a primary care doctor and access to specialists and hospitals would require the primary care physician’s referral. HMOs are generally more satisfactory for people who generally have few medical demands and usually need only preventive care.
The PPO offers more latitude than an HMO. The PPO also includes a network of providers for plan members, but PPOs allow you to go out of the network for coverage, though going out-of-network is usually more expensive. The costs of PPO membership–the premiums you pay, for example–are generally more expensive than HMOs, but the level of coverage is often greater. PPOs do not require referrals to see specialists, though you do want to be sure that out-of-network providers accept the insurance and therefore accept the company’s payment rate. Examples of national insurance offering PPO plans would include Anthem Blue Cross, Humana, Aetna, Cigna, Tonik, and Wellmark.
Another common sort of managed care plan is the private fee for service plan (PFFS). The PFFS has no pre-established network of doctors and hospitals and leaves your choice of provider up to you. It is important, therefore, that your doctors agree to accept the plan’s payment terms, and that you find out before you receive services if you doctors submit claims to the insurance company. Rather than offering you a fixed package of benefits, as is the case in an HMO or PPO, your providers bill the PFFS a fee for each service you receive, and the PFFS pays for each service according to its fee schedule, or payment rate.
Just what are the real costs of a health insurance policy? The answer to that question will depend in part on the cost of monthly premiums, the deductibles, and the co-pays and co-insurances that you can expect to pay. There is another factor as well that is often ignored, and that is the reliability of the insurance company. If possible, you want to get the best idea you can of the actual reputation of the company for meeting its coverage obligations. In other words, is the company going to pay on the claims per the policy agreement, or will you have to fight every step of the way for your health care. You can see that a plan with a cheap premium could turn out to cost more than a more expensive plan if less expensive plan refuses to pay the medical claims.
You can find cheap quotes for health insurance, but the key to a low cost plan is in coming as close as you can to paying only for a relatively few number of key services. In other words, if possible, you strip the policy of every service you can possibly do away with and assume as high a deductible as possible. Also, you must verify the reliability of the company because it’s important that they pay promptly and without argument should a time of need arise.
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