Sifting through all the information while looking for private health insurance can be difficult. There are several sources to choose from when trying to find help on understanding all the different plans and policies.
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According to the NYC Human Resources Administration, some of the common health insurance benefits are coverage for injuries, illnesses, diagnostic tests. Health insurance plans typically cover preventative care such as doctor’s appointments, physicals, and vaccinations.
What are the different types of coverage options?
There are several different types of coverage with private health insurance. One is the traditional health insurance option which is better known as fee for service plans. Fee for service plans are the most flexible of health plans mainly because you can choose your doctor without having to get prior approval from your health insurance company. Coinsurance and deductibles apply for this type of coverage and the insurance company and insured will pay for part of the overall costs of health care services needed.
HMO insurance plans or health maintenance organization plans are when an insurance company uses or contracts with a network of hospitals, doctors and specialists. Most require that the insured get a primary care physician in the network. You’ll have to receive a referral if you need additional medical care.
PPO plans or preferred provider organization are similar to HMO plans however, you don’t have to have a primary care physician in order to coordinate your care. There are a network of providers, doctors and hospitals you may choose from, but it’s preferred that you refer yourself to those professionals within the network.
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Point of service insurance plans or POS plans are a little more flexible. You can choose from providers in the network or preferred specialist or outside the network. However, if you choose outside of the network the deductibles and copayments tend to be more expensive.
EPO or exclusive provider organizations are very similar to HMO plans as well. However, patients are usually not reimbursed for care that was received by a provider outside of the network. The only exception is in emergency cases. Coordinated care through a primary care physician is required before receiving care.
Another health plan that is used is called high deductible health plans or HDHP plans. This is where there is a minimum deductible of $1200 for just one person and it’s doubled for family coverage. Customers of HDHP plans will pay higher deductibles than others with different plans, but these plans partner with a health savings account or a health reimbursement arrangement that will allow the insured to make tax deductions for future medical expenses.
What are the fees and costs?
There are other out of pocket expenses to consider when looking for private health insurance. It’s important to become familiar with these terms before signing with any insurance company. Premiums are the monthly payments or annual payment you make to receive health insurance. These rates can vary depending on several factors including your health history.
Copayments and coinsurance or two other out of pocket expenses well known in the health insurance industry. The copayment is a flat fee you pay for certain services such as a doctor’s appointment. You could pay a $25 copayment every time you go to the doctor’s office for a checkup.
Coinsurance is a percentage you pay of the actually overall cost of the services you receive. This is usually somewhere in the 20 to 30% range. If you pay 20% of the cost of a doctor’s visit than the insurance company will pay the other 80 %.
Deductibles are common with most plans. This is where the insured will pay a set amount of the medical expenses out of pocket before the insurance company takes over and covers the rest of the expenses.
Some plans will limit the total amount of out of pocket fees for an individual or family plan. This is called maximum out of pocket fees. A lifetime maximum is the total amount of benefits the health insurance company will pay during the life of the insurance policy.
Who do you contact for help?
You should always check into the financial health of an insurance company before purchasing their health insurance plan. According to the Centers for Medicare and Medicaid Services, individuals and families can get some protection when they need to buy, change or continue your health insurance whether it be private or government funded.
You can always seek out quotes from online websites to get a good idea of the health insurance options available. For those who need more in depth information you can always seek the help of an insurance agent or broker.
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