The amount of personal health insurance you need is really a personal decision. However, you should make sure that you have enough health insurance to cover medical expenses that you know you are going to experience as well as the medical expenses that are unexpected.
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Personal health insurance should provide sufficient benefits so that you are not going into debt because of your needs. Health insurance should cover:
- Physician expenses
- Laboratory tests
- Preventive care
- Emergency services
- Prescription drugs
Additional benefits that you may or may not deem necessary are vision insurance, hearing coverage, dental health insurance, and mental health benefits.
How can I get personal health insurance?
There are three ways to obtain personal coverage:
- If your employer offers group health insurance, you can see if you qualify for a group insurance plan.
- If your employer does not offer group health insurance, you can see if you are eligible for state health insurance through Medicaid.
- Lastly, if you do not have the option of group insurance and you do not qualify for state health insurance, you may need to purchase private coverage through an agency or broker.
What are the types of personal health insurance?
There are five basic types of personal coverage:
First, there are the Health Maintenance Organizations also known as HMO’s. These are the most affordable, because you have to use the insurance company’s in network physicians, hospitals, and pharmacies to receive benefits. You are usually responsible for co-payments but not deductibles. The insurance company will not pay for medical expenses if they are out of network.
The second type of insurance is the Preferred Provider Organization or PPO. This plan is more expensive than the HMO plan, because you can choose your doctor, hospital, or pharmacy. There is usually a deductible that you have to meet before the company begins paying for benefits. There is also a co-payment or an agreed upon payment amount that the insurance company has established with the medical providers.
The third type of plan is a Point of Service plan also known as a POS. The plan is a cross between a PPO and a HMO, because you choose a primary physician who will provide referrals for medical specialists. However, if you choose to see an out of network provider, the company will still pay benefits towards your claims.
The next type of insurance is the Health Savings Plan, which includes a high deductible and a Health Savings Account or Health Reimbursement Arrangement where you or the employer can put pre-tax money aside for medical expenses. You can usually see any providers you like, but may get a better rate if you see providers that the insurance company has an established negotiated rate.
Lastly, there is the Fee for Service plan or FFS plan. Under this plan, you are also free to see providers of your choice. You are simply reimbursed a particular amount after a claim is submitted.
What if I need additional features on my plan?
You might need to find insurance plans that provide coverage for additional medical expenses such as vision, hearing, or mental health care. If you know you have these types of medical expenses regularly, it is worth purchasing policies or medical riders that offer these features, as it could save you a lot of money. These riders or policies are usually quite affordable.
How much is personal health insurance?
Personal cost is going to depend greatly on:
- The plan you choose
- Where you live
- Your marital status
- Whether you smoke or not
- Male or female
- Any pre-existing conditions
The cost of personal health insurance is calculated depending on the premium, deductible, and co-payments. A lower premium will often result in a higher deductible and co-payment, whereas a higher premium will usually have a lower deductible and co-payment.
The best way to determine the amount of insurance you can afford is by using an insurance calculator. Insurance calculators can be found online.
How can I choose the best health insurance company?
According to Consumer Reports, not all insurance companies are created equal. In fact, Consumer Reports rated a number of insurance companies and found some interesting results. For instance, you do not necessarily need to go with a big name insurance company to receive the best coverage.
Remember that a good insurance plan will begin paying 100% once your deductible is met. Avoid purchasing medical insurance from telemarketers or health-sharing ministries, as they will not provide the coverage you need, and you will be stuck with expensive medical bills.
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