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What Questions to Ask When Choosing Health Insurance

To sum it up...
  • Decide what level of coverage you want
  • Seek information about different plans, HMO, PPO, Indemnity, etc.
  • Examine the options and cost of the desired plan

When buying insurance through your employer or some other agency, there are questions that need to be asked. Not only do these questions need to be asked to determine the cost of the insurance, but also to determine the coverage limits, co-pays, and deductibles.

To start your personal investigation, consider these steps as recommended WebMD.Com. The 10 subjects are listed below. The answer to some of the listed questions is obvious, but others may require additional explanations.

  1. What type of plan is being offered?
  2. What will be the cost of the policy?
  3. Will I be able to use my current doctors?
  4. What benefits are included?
  5. Are routine examinations covered?
  6. Will I be required to call my physician before entering the emergency room?
  7. What are the restrictions regarding pre-existing conditions?
  8. What happens when I away from home?
  9. Is the insurance company financially stable?
  10. How are claim disputes handled?

Some of the answers will differ depending on whether an individual policy is being purchased, a policy is being offered by an employee or if the policy is connected to an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).

As a result of the Affordable Care Act (ACA), co ‘Obamacare’, no person can be denied coverage because of prior or current medical conditions. That does not guarantee a low price, but it does assure everyone that they can purchase insurance.

Furthermore, keep in mind that because of the ACA, everyone is required to have insurance. Some will choose to have a high-deductible plan and others will opt for the more traditional plan. Those persons that do not want insurance can pay a fee to be exempted from coverage.

Finally, remember that a new administration will be coming in on Jan. 20, 2017, and accordingly there may be some changes to the insurance laws. It will be necessary to be vigilant about any changes that may take place and how they will affect you.

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What type of plan is being offered?

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There are basically three types of plans, including indemnity coverage, managed care, and employee provided, which will usually be a part of the indemnity coverage. The managed care will offer several categories of insurance, including HMO, PPO, and employer plan.

– Indemnity Coverage

Much of the insurance available today is through a managed-care plan, which can have some restrictions that help to lower the overall cost of health insurance. An Indemnity Plan lets the patient chose any doctor or medical facility they want and set the amount, either as a fixed sum for office visits or percentage of the total bill. It provides more latitude in choosing doctors. However, it may not provide the same savings as a Managed-Care Plan;

– Managed Care: HMO

This type of coverage is available through either a Health Maintenance Organization (HMO). There are restrictions. In the HMO model, the participants will have to pay a set fee every month. There will be no co-pays at the doctor’s office. The designated primary doctor will be responsible for any needed referrals to a specialist. The patient cannot go outside the network unless he wants to pay the entire cost of the visit himself.

– Managed Care: PPO

With the PPO plan, the patients are able to see any doctor that is part of the plan. It is not necessary to designate a primary care physician (PCP) and it is not mandated to have the specialist make referrals to other specialists.

– The Cost of the Policy

The policy cost will depend on the type of policy. The Indemnity and HMO policies will require monthly fees. The PPO will have charges at the point of service.

– Can you keep your current doctor?

In the case of the indemnity policy, you can continue to see your current physician. Persons 65 or older and covered by Original Medicare, or an employer’s policy, can continue seeing the same physicians. However, the doctor you prefer may not choose to accept the policy you purchased or accept Medicare. In the HMO and PPO programs, you will have to choose your doctor from a directory provided by each program.

– What benefits are included?

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All the plans cover basic hospital and doctor expenses. HMOs and PPOs may provide dental coverage, vision coverage, and prescription services. Each program is a little different, and it is incumbent upon the patient or trusted adviser to determine if the needed types of coverage are available.

– Pre-Existing Conditions

Before the enactment of the Affordable Care act, persons with pre-existing conditions, who needed a new policy, often ran into trouble. If you had any adverse medical conditions, you usually could not get good coverage. Under current laws, you cannot be turned down for prior conditions, and if you are covered by Medicare, the issue should never come up.

– When You Are Away From Home

Insurance generally covers a precise geographic area. Accordingly, before traveling take the following steps. Contact your insurance carrier regarding coverage if away from your home area. The distance you are traveling and the illness or injury you may incur could affect the coverage. Some companies do not provide coverage or very limited coverage outside of the plan area. Thus, it is wise to invest in travel insurance, which is relatively inexpensive and provides good coverage. The simple thing to do is plan ahead.

– Financial Stability of the Insurance Company

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 If coverage is from a well-known company, it is probably stable. However, if the name is not familiar, then it would be wise to check with the Insurance Commission in your state. The position may have different names. Those agencies are responsible for keeping track of the company’s solvency and other related factors.

– Claim Disputes

Sometimes an insurance company does not cover the cost of an injury, illness, test result or other malady. Usually, there is some method of appeal, allowing claims to be paid for certain circumstances, depending on the policy. In other cases, the insurance company may win and will not be required to cover the disputed cost. In cases like that, the customer can take legal action, where he might win or lose, or the customer can just accept the decision of the insurance company.

Conclusion

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Health insurance is something everyone needs. The Affordable Care Act requires everyone to be insured or to pay a fee each year. Insurance, as already noted can come in many different forms, including employer coverage, individual policies, group policies and other types.

One of the myths about health insurance is that you can double coverage. In this scenario, one person would have a group policy, and either an employer provided policy or individual policy. It is impossible to get double coverage and expecting a cash pay-off.

Every insurance policy has a Coordination of Benefits Clause. This simply states that the primary policy will pay first.

However, in no case will the benefits that may be provided for a particular claim, will ever exceed the cost of that claim.

However, there is one case where having two policies may prove beneficial. Assume that one spouse’s employer offers a better health plan. The policy offered to the other spouse is not as good. The entire family can be insured under the better plan, and the other spouse can get minimum coverage. If the first spouse becomes unemployed, the other policy could probably pick up the rest of the family. Granted there is some duplication of cost, but it might prove beneficial.

Finally, the key to having a successful health insurance plan is research. No plan can deny a person for pre-existing conditions. However, the premium may be more expensive. Insurance plans for working people are different than those available to retired people who use Medicare or a Medicare Advantage Plan.

The main thing to do is to ask a lot of questions. Getting recommendations from friends and family may be helpful, but it is necessary that people purchasing insurance be fully aware of what the plan offers, the premium cost and the stability of the company.

The main thing to do is to ask a lot of questions. Getting recommendations from friends and family may be helpful, but it is necessary that people purchasing insurance be fully aware of what the plan offers, the premium cost and the stability of the company.

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