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What is medical health insurance?

diverse group of people health insuranceMedical health insurance is another term for health insurance. Medical health insurance is designed to cover medical expenses that you know are going to happen as well as those medical expenses that catch you off guard.

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There are many forms of medical health insurance available to help you meet your needs. The article below explains the various types of medical health insurance.

What types of medical health insurance are available?

According to the South Carolina Department of Insurance, there are major medical plans and limited benefit plans. Within these two types of medical health insurance plans, are various types of policies to meet your health care needs.

What kinds of medical health insurance plans are available under major medical plans?

Four types of traditional medical health insurance plans that fall under major medical plans:

  • HMO
  • PPO
  • POS
  • Indemnity plans

The first plan is an HMO or Health Maintenance Organization plan. Under this plan, individuals choose a primary care physician whom they see for all medical problems.

The primary care physician will refer the patient to specialists when necessary. Policyholders must see providers within the established network for the insurance company to pay any claims. Patients are usually responsible for a co-payment upon seeing a provider.

The second plan is a PPO or Preferred Provider Organization plan. Under this plan, there are providers that are within the PPO’s network. You do not need a referral to see a provider, but an in-network provider will be less expensive than seeing an out of network provider. There is usually a co-payment involved, which does not go away until the deductible is met.

The third plan is a POS or Point of Service plan that is a cross between the HMO and PPO plans in that there is an established network of providers and co-payments. You do not need to start with a primary physician with all of your medical problems. You can also go out of network, but the cost will be higher than staying within the network.

Lastly, there is what is known as indemnity plans. These are strictly deductible plans where you can see whomever you wish for your medical care, but the insurance company will not pay anything until the deductible is met. Once the deductible is met, the split of the cost is usually 80/20.

What kinds of medical health insurance plans are available under the limited benefit plans?

Under the limited benefit plans, there are five different types of medical health insurance plans, which only cover a specific type of medical expense.

For instance, you can purchase hospitalization coverage. Hospitalization coverage only pays for medical expenses occurred while admitted to a hospital as an inpatient or outpatient.

Next, there are plans, which only cover surgery. Under these plans, your entire surgery is covered as well as any hospitalization that is required due to the surgery.

The third limited benefit plan is hospital confinement indemnity coverage. Under this type of plan, the insurance company will pay a set amount for each day you are admitted to a hospital. The insurance company and hospital have an agreed upon amount so payments are not based on actual expenses.

Another option is purchasing a policy that covers certain diseases. Under these plans, you can receive care and medical benefits for diseases like cancer, heart attack, or stroke.

Disability income plans are responsible for paying wages if you become disabled and can no longer work. There is usually a set amount, which lasts for a certain amount of time.

Accident only is the last type of limited benefit plan. The accident only type of policies cover:

  • Loss of limbs
  • Loss of life
  • Disability
  • Hospital or medical care which results from an accident

Addendums can be purchased under these plans to cover specific forms of accidents.

Some insurance companies classify mental health, vision, and dental under their limited benefit plans. Other insurance companies simply include it as part of their major medical plan.

What additional plans are available for retirees?

Supplemental insurance also known as Medigap is a popular choice for individuals on Medicare who need additional coverage to pay for medical expenses that Medicare does not pay for or is quite limited in its coverage. You can learn more about Medigap coverage on the Medicare website.

Long-term care is another option worth reviewing as you begin thinking about retirement. This covers:

  • In-home care
  • Nursing home care
  • Assisted living facilities
  • Adult day care

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