Why do you need health insurance

Why do you need health insurance

Nitin Gupta asked:


The United States has no socialization of medical care. If you do not have health insurance coverage, you have to pay for health care of your finances at the time of service. It can work in several thousand dollars for serious illnesses.

You buy health insurance for the same reason you buy other types of insurance to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very costly.

You can not predict what the medical bills. In a good year, your costs will be low in May. But if you fall ill, your bills can be very high. If you have health insurance, many of your costs are covered by a third party payer, not by you. A third-party payer can be an insurance company or, in some cases it may be your employer.

Many people in the United States are enrolled in a managed care health insurance. This is an organized way of both providing services and paying for them. Different types of management plans of care and work differently preferred provider organizations (PPOs), health organizations (HMOs), point-of-service (POS) plans and compensation plans of service.

Individuals enrolled in the health care plan pay a monthly or quarterly insurance for when they need medical care. When a service is provided, the health insurance company takes responsibility for part or all of the tax, reducing the amount you pay to receive the service.

The information presented here will help you choose a health insurance plan that is good for you. If you are married or single, have children or no children, this information will help you find how to choose a health insurance plan that best meets your needs and your financial situation. Definitions of health insurance terms used are included in the section called Understanding Health Insurance Terms.

Understanding Health Insurance Terms

Coinsurance

The amount you are required to pay for medical care in a service charge after the plan you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the health insurance company pays 80 percent of demand, you pay 20 per cent.

Coordination of benefits

A system to eliminate duplication of benefits when you are covered by more than one group plan. Benefits under both plans are generally limited to a maximum of 100 percent of demand.

Co-payment

Another way of sharing medical costs. You pay a fixed amount each time you receive a medical service (eg, $ 5 for each visit to the doctor). The insurance company pays the rest.

Expenditure

Most health insurance plans, including fees for service, HMOs, or PPOs, do not pay for all services. Some May not pay for prescription drugs. May others not to pay for mental health care. Services covered are the medical procedures the insurer agrees to pay. They are listed in the health insurance policy.

Customary Fee

Most insurance plans will pay only what they call a reasonable fee and a service. If your doctor charges $ 1,000 for a hernia repair while most doctors in your area charge only $ 600, you will be billed for the $ 400 difference. This is in addition to the deductible and coinsurance you would pay. To avoid this additional cost, ask your doctor about your medical condition to accept the insurance payment as payment in full. Or shop around to find a doctor who will. Otherwise, you must pay the rest yourself.

Franchise

The amount of money you must pay each year to cover your medical expenses before your health insurance policy begins to pay.

Exclusions

Specific conditions or circumstances for which the policy does not provide benefits.

HMO (Health Maintenance Organization)

Prepaid health plans. You pay a monthly premium and the HMO covers your doctor visits, hospital stays, emergency care, surgery, examinations, laboratory tests, X-rays, and therapy. You must use doctors and hospitals designated by the HMO.

Managed Care

Ways to manage costs, use and quality of health care system. All HMOs and PPOs, and many service charge plans, managed care.

Maximum expenditure

The more money you will pay a one-year exemption and the insurer. It is stated a dollar amount set by the health insurance company, in addition to the premiums.

Non-cancelable policy

A policy which ensures that you can receive health insurance as long as you pay the premium. It is also called a guaranteed renewable policy.

PPO (Preferred Provider Organization)

A combination of traditional fee for service and an HMO. When you use doctors and hospitals that are part of the PPO, you can have more of your medical expenses covered. You can use other doctors, but at a higher cost.

Preexisting

A health problem that existed before the date your insurance became effective.

Premium

The amount you or your employer pays in exchange for health insurance. Primary Care Doctor

Usually, your first contact for health care. This is often a family physician or internist, but some women use their gynecologist. A primary care doctor to monitor your health and diagnoses and treats minor health problems and refer you to specialists if another level of care is needed. In many health insurance plans, care by specialists is only paid if you are referred by your primary care physician. An HMO or a POS plan will provide a list of doctors from which you choose your primary care doctor (usually a family physician, internists, obstetrician-gynecologist, or pedicatrician). This could mean that you may have to choose a new primary care doctor if your present is not part of the plan. PPOs allow members to use primary care doctors outside the PPO network (at a higher cost). Indemnity plans allow any doctor to be used. Provider

Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.

Third-party payer

Any payer for health care services other than you. This may be an insurance company, an HMO, the PPO, or the federal government