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What does private health insurance cover?

private health insurance coverageAfter a private health insurance comparison you will find that these plans will cover everything from routine doctor visits to major medical expenses according to the limits set forth under the subscriber’s specific plan.  A plan aimed more at preventive and routine care will have lower limits and higher deductibles for major medical coverage. A plan focused more on catastrophic care might offer less coverage for regular doctor visits and routine care.


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Believe it or not, if you have health insurance through your employer, a union, or another large group, you have private health insurance. The U.S. Census Bureau defines private health insurance as “coverage by a health plan provided through an employer or union.” It can be purchased in a group setting or directly from the provider to the subscriber.

Is my HMO considered private health insurance?

Unless your health maintenance organization (HMO) plan is directly funded by federal or state government, it qualifies as private health insurance. In fact, any health insurance plan not funded by government entities is considered private insurance. Since your HMO insurance is funded by the members of your group and administered by a private insurance company, it qualifies as private health insurance. The same can be said about major medical plans, preferred provider organization (PPOs), and any other type of health plan.

According to the Centers for Disease Control and Prevention (CDC) the most recent census data indicates that more than 61% of all Americans under the age of 65 are covered by some form of private health insurance. The data further reveals just over 18% with no health insurance at all, leaving approximately 21% of those under the age of 65 being covered by public health insurance. The two biggest sources of public health insurance are the Medicare and Medicaid programs.

Am I covered when I travel?

It’s hard to give specific details about any one type of plan because they’re all so different.

As a general rule however, most standard private health insurance plans do provide at least basic coverage when you travel as long as the facilities you utilize for healthcare will accept payment from your plan.

Be advised that your plan may have limits so restrictive as to make your travel coverage virtually useless. Your plan may also not offer any coverage at all while you’re traveling. Be wise and check your policy documents before you travel.

If your private health insurance plan doesn’t offer coverage when you’re traveling, or your coverage is inadequate, you can purchase travel health insurance coverage from dozens of sources around the country. Typically these plans include not only health insurance but also coverage against accidental death and dismemberment, damage to rental vehicles, lost luggage, and stolen property. The nice thing about these policies is that they can be highly customized.

What about the costs of a major illness?

what private health insurance coversMajor illnesses, such as cancer or Alzheimer’s disease, often put a strain on even the best health care plans. It’s rare to find a plan that will cover all the expenses of treating such diseases for as long as the patient lives. Those that do are considered top-notch plans, and they cost a lot of money. For the rest of us, the typical private health insurance plan will cover the expenses related to major illnesses up to a predetermined annual limit.

As an example, your plan might have a $50,000 annual limit for major illnesses like cancer. Once that limit is exhausted you would be responsible for making arrangements to pay for the remainder of your treatment. You might work out payment plans with your hospital and oncologist, seek the financial help of a cancer charity, or even apply for government assistance under Medicaid or Medicare.

Some people purchase long term or supplemental health insurance policies to cover against the likelihood of such major illnesses occurring. Using cancer as an example again, you can purchase a specialized, supplemental policy to cover cancer treatments if family history or other circumstances indicate you might be a cancer patient in the future. In order to purchase these types of policies you must be healthy at the time of application.

If you have private health insurance you can find out what your policy covers by reading your policy documents. If you still have questions, contact your carrier directly. Between the two you should be able to figure out the extent of your coverage.

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