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Healthcare is expensive. If you don’t have health insurance,  you take a big risk. Medical costs are so high that if you have to pay them on your own, you will likely find that your costs exceed what it would have cost you to buy adequate insurance coverage in the first place.

One of the best ways to obtain health insurance at a reasonable cost is through your employer, if your employer provides subsidized insurance. If it is available to you, don’t pass up on insurance coverage offered by your employer.

Not every employer offers health insurance. If not, you need to find the best independent insurance coverage for you and your family.  If your employer does subsidize your insurance coverage, you may have more than one option to choose from. To figure out what type of health insurance coverage best suits your needs, you should compare the different options available. This way, you can find health insurance that you can afford and that will properly protect you and your family.

When you shop for health insurance, keep in mind that the health insurance with the cheapest premium is not necessarily the best coverage for you to buy. Monthly cost is certainly an important factor, but it must be weighed against the benefits you receive. You don’t want to save money on your monthly insurance premium only to see your monthly savings disappear. Before you select a policy, review your standard medical, dental, vision, and prescription needs. Choose the type of coverage that best addresses your specific needs.  Consider your past history,  family history, expected health needs (such as a planned pregnancy) and your current health. These factors need to be weighed, along with your finding an insurance premium that fits your budget.

There are a variety of health insurance plans to choose from. A rule-of-thumb is that the more flexibility you demand from your health care insurance, the more you'll pay. Costs are lower with managed care plans, such as  HMOs (health maintenance organizations), than with coverage that lets you choose your doctor. Within different insurance plans, you can select from different levels of care. If you choose the highest level of coverage that comes with the most benefits, your premiums will be higher.

Compare the benefits the plans offer, working to buy coverage that covers your standard preventative and maintenance care and guards you adequately from heavy costs associated with hospitalization and catastrophic care. Of course, you need to find insurance coverage that fits within your monthly budget, but make sure to look at the big picture, before deciding what kind of policy is best.

Review the articles and tools at Bills.com to learn more about the types of health insurance available, how to figure out what insurance is right for you, and how to shop effectively to get the most for your money.

  • Can I purchase family health insurance coverage with my domestic partner?

    It depends on the state in which you live in. If you reside in a state that recognizes domestic partnerships and you and your partner registered as domestic partners, then you will be able buy family health insurance.

  • Can my insurance company cancel my policy or raise my rates?

    State insurance regulations will protect you from a cancellation of your policy or an increase in your rates, if you purchased your policy from a licensed insurance provider. There is no reason that your insurance company can cancel your policy or raise your rates, unless your insurance carrier cancels everyone else's policy, or raises everyone else’s rates at the same time and with the same amount applied to anyone else of your age, sex, and area of residence.

  • How does a managed care plan work?

    A managed care plan has a network of health care providers that contract with the insurance company to provide their services at an agreed-upon rate. This allows the insurance company to control costs, as it knows how much to expect to pay for any given service. Because the insurance company has made prior arrangements with these providers, paperwork can be filed directly between the provider and the insurance company. Some managed care plans keep their costs down by coordinating all of your care through your personal care physician (PCP). Some managed care plans cover only costs associated with visits you make to network providers, while others may cover some costs of out-of-network care.

  • What are the main differences between a group health plan and an individual plan?

    Group insurance plans require that you be a member of a group that is eligible for the group policy, such as employee that works for an employer offering group insurance. There is no such restriction for individual insurance. Another key difference between the two is that you are subject to individual risk analysis for an individual policy; you can be denied coverage because of a pre-existing health condition you have. With group insurance, you are not subject to individual risk analysis and cannot be denied coverage for a pre-existing. Lastly, individual insurance is portable; you can take it with you if you relocate or if you lose your job. Group insurance is lost, once you are no longer a member of the group.  If you have group insurance through your work and lose your job, you lose your insurance coverage, although there is a temporary period where you can keep the coverage by paying for the insurance on your own.

  • What are the main differences between HMO and PPO?

    Both HMOs and PPOs are types of managed care plans with networks of care providers. There are two main difference. HMOs require you to select a primary care physician (PCP) who supervises all your care issues all referrals to other care providers.  PPOs do not have PCPs. The other main difference is that an HMO restricts coverage to care providers that are part of its network. In a PPO, you can see care providers who are not part of the network and still be covered.  In a PPO, your costs for out-of-network care are usually not covered to he same extent as in-network care that you receive.  

  • What is a deductible?

    A deductible is a specific dollar amount that you must pay before your insurance company begins reimbursing you for payment. Generally, the higher the deductible, the lower the cost of the health insurance plan. Deductibles are usually calculated on an annual basis, with you having to satisfy the deductible each year before reimbursement begins.  Within a policy, the deductible can vary for different types of procedures.

  • What is health insurance?

    Health insurance is an insurance policy that promises to pay for healthcare services for the insured party in exchange for the payment of premiums. The type of services covered and the level of coverage are specified in the policy. Types of health insurance include group or individual policies. Health insurance also covers the delivery of medical care and services.  Insurance plans can be managed care plans or fee-for-services plans.

  • What types of health policies are available?

    There  are four main types of health insurance policies available to consumers: health maintenance organizations (HMOs), the point-of-service plan, preferred provider organizations (PPOS) , and the traditional individual health indemnity plan. The price of the policies varies not only amongst the different plans, but also within the plans, depending on the level of coverage you purchase.

  • When can I add my spouse to my health insurance policy?

    It depends on what kind of coverage you have. If you have a group insurance policy, you can only change your benefits when there is an open enrollment period or of you experience what is called a 'qualifying event.' Marriage is a qualifying event, as is divorce or loss of your previous medical coverage from a spouse's policy. Contact your insurance company or your employer's human resources department ASAP, as there can be a 30 day window for making changes after the qualifying event. The rules for individual policies are different and vary from state to state. For individual policies the people you wish to add to the policy may need to be reviewed for eligibility and could be excluded from coverage for a pre-existing conditions

  • Authorization

    An authorization is an approval granted by your insurance provider to pay for any treatment or care that is covered by your insurance policy. If you receive care that is not authorized, you will bear the full financial costs.  In  an HMO, authorization is permission to receive the treatment or care that you get from the HMO before the care is given.

  • Co-insurance

    Co-insurance is the portion of your medical care you are responsible for paying, after your insurance company pays its portion, and after your deductible has been paid. Your co-insurance responsibility is usually defined as a specific percentage of the costs for your care.  For example, once your deductible has been paid, if you have 80/20 coverage, you pay 20% of the cost and your insurance company pays the other 80%.

  • Co-payment

    A co-payment is a flat fee that you pay for a specific health care service, such as an office visit or a prescription, that is in addition to what you pay in a monthly fee or premium for you health insurance. Co-payments are a common feature of managed care health plans. Your co-payment can vary from service to service within your plan.

  • Complaint

    A complaint is when you contact your health insurance provider to express dissatisfaction with the healthcare you received or the financial coverage authorized.

  • Deductible

    Your deductible is the amount you must pay for your medical care before your insurance starts paying the costs. Most deductibles are calculated annually.

  • Denial of Claim

    A denial of claim is the refusal of your insurance provider to honor your or your healthcare provider's request to pay for healthcare services you received.

  • Dental Health Maintenance (DHMO)

    A DHMO is managed dental healthcare plan. You pay a monthly fee to receive care from the network of care providers within the DHMO.

  • Dental Preferred Provider Organization (DPPO)

    A DPPO is a managed dental healthcare plan. A DPPO  consists of a network of dental care providers that agree to accept payment for your dental care according to the fee structure determined by the insurance plan provider. You can go outside the network for your care, but you will pay all the costs or a higher percentage of the costs than for in-network care.

  • Exclusion

    An exclusion is provision in your health insurance policy that eliminates coverage for certain treatments.

  • Fee-for-service

    Fee-for-service is a type of health care delivery system where you pay your care provider a fee for each service, treatment, or prescription you receive. After you pay the fee, you or your care provider submit paperwork to your insurance provider, so you can be reimbursed for the portion of the costs you paid for that your insurance covers.

  • Fee-for-services plan

    Fee-for-services plans are also called indemnity plans. They are benefit payment system in which your insurer reimburses you or pays your care provider directly for each covered medical expense, after the expense has been incurred.

  • Group Health Plan

    Group health insurance is an insurance plan that provides healthcare coverage to you if are a member of a qualifying group. Examples are employees covered under a group plan offered by the employers , union members covered under a  group plan offered by the union, or members of trade associations covered under plans offered through the association. Members of the group are not subject to individual underwriting.  If you have a pre-existing condition that makes qualifying for individual insurance problematic, you will not be turned down for a group insurance, if you are a member of a qualified group.

  • Health Maintenance Organizations (HMOs)

    An HMO is a managed healthcare plan. You pay a monthly premium for medical services provided by a network of hospitals, doctors and other health care providers that contract with the HMO. Many services require a co-payment. A distinguishing feature of HMOs is that you must first see your primary care physician (PCP), before you can see any specialist. All referrals go through the PCP.

  • Indemnity Plan

    An Indemnity plan, also called a fee-for-services plan, is a type of medical insurance plan that reimburses you or your care provider, after the expenses are incurred.

  • Insurance Agent

    A representative working on behalf of one or more insurance companies who has been authorized to sell and service insurance contracts.

  • Insurance Claim

    A claim is a request that you or your care provider make to your insurance company for the insurance company to pay all or part of the costs of the medical services you obtained.

  • Insurance Policy

    A contract obligating the insurer to pay for particular losses and provide specific services in the event that certain events take place (such as a car accident, an illness, or a home fire).

  • Insurance Premium

    The agreed upon amount that a policy holder pays the insurance company for the insurance policy coverage. Depending on the type of insurance, the premium may be payable annually, semi-annually, monthly or even twice a month.

  • Insurance Quote

    An insurance quote is the estimated amount for the insurance premium for coverage specified in an insurance policy.

  • Managed Care

    Managed care integrates the financing and the delivery of healthcare in one system. Managed care attempts to control the cost, access to,  and quality of the healthcare system it manages.

  • Managed Care Plans

    Managed care plans usually provide comprehensive health services offered through a network of healthcare providers. They either restrict care to providers within the network or offer financial incentives for patients to use the network providers. Examples of managed care plans are HMOs, PPOs, and POS plans.

  • Network

    A network is a group of  health care providers contracted to provide services to managed care plan's and insurance company's customers for less than their standard fees.

  • Out-of-network Care

    Out-of-network care is when you seek healthcare from any care provider that is not part of your managed care plan's network of providers. Some managed care plans exclude coverage for out-of-network care, while others may cover a portion of the costs.

  • Point-of-service Plan (POS)

    A POS is a hybrid of HMO and PPO insurance plans. You have a primary care physician, like an HMO. You can seek coverage outside of your network, like in a PPO.

  • Pre-existing Condition

    A pre-existing condition is a medical condition that is excluded from coverage by your insurance company because the condition was believed to exist prior to the time that you obtained your insurance coverage.

  • Preferred Provider Organizations (PPOs)

    A PPO is a type of managed healthcare plan with a network of care providers. In a PPO, you do not have a  primary care physician. You are not restricted to seeking care within the network, however, your costs are likely to be higher when using a care provider who is not part of the network.

  • Primary Care Physician (PCP)

    A PCP is a doctor who is your first contact within a managed care plan's healthcare system.  The requirement to select a PCP is a feature of some managed care plans.  For you to see a medical specialist, it is often necessary for you be referred to the specialist by your PCP.

  • Provider

    A provider is a healthcare professional that provides services to patients.

  • Referral

    A referral is a recommendation by a physician or healthcare provider for you to be evaluated or treated by a different physician or care provider. In an HMO, almost every referral must come from your primary care physician.

  • Specialist

    A specialist is a physician or healthcare provider who is certified to treat a specific body system,  such as a neurologist (nervous), gynecologist (woman's reproductive system), or hematologist (blood). Specialists can also be physicians or care providers whose expertise is certified in a certain area of care, such as an oncologist (cancer), radiologist (x-rays and using radiation for treatment) or a surgeon.

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