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4 Types of Healthcare Insurance and How It Works

Americans need to have health insurance. Why? Because it is too expensive to pay for from your own pocket. We have one of the most expensive healthcare systems in the world. If you were to get in an accident and had to pay your medical bills yourself, you would be bankrupt the moment the car hot you. Our healthcare system has made difficult to access and pay for healthcare. This is why we need health insurance to cover part of the costs so we don’t have to sell everything we own to pay for a doctor’s bill.

Today, we want to share some insight in healthcare insurance in America.

Plan Rankings

Plans are different on the basis of the benefits that they offer. You can usually choose from bronze, silver, gold, and platinum. Each has a different amount of coverage for your medical expenses. Bronze plans usually cover up to 60% of healthcare costs. Silver plans cover up to 70%. Gold plans cover up to 80% of costs and platinum plans cover up to 90% of healthcare costs.  The remainder of the costs is payable by you. Your choice of health insurance will depend on different factors that we will discuss later. What is important to understand about these rankings is that the more the insurance covers, the higher your monthly fees will be.

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Where Do You Buy Insurance?

In America, you can health insurance from the Marketplace or through a health insurance broker. They can offer advice on what you need, the monthly fees, brands, etc.

Available Brands

We have a few well-known and trusted health insurance brands in America. Some of the names you may recognize include Cigna, Kaiser, United, Cross Blue Shield, and Aetna. You choose a brand based on preference, the benefits they offer, etc.

Available Plans

Most of the brands mentioned above will offer you the option of four types of health insurance. Let’s have a look at these.

  1. Health Maintenance Organization (HMOs) – These types of plans are restricted in the choice of healthcare providers. They have a specific network of doctors and specialists that you can go to for your healthcare needs. You cannot just go to anyone, they must be in the network. These plans will also often require authorization or a referral before you can go to a specialist.
  2. Preferred Provider Organizations (PPOs) – These plans are less restricted than HMOs but also carry some restrictions as to the doctors and specialists you can see. You probably won’t need authorization to see a specialist. If you go to healthcare providers outside the network, you will have to pay the full bill and expect to have higher out-of-pocket costs than with other plans.
  3. Point-of-Service Plans (POS) – This type of plan is a combination of an HMO and a PPO. This means that you have more options for healthcare providers and that you will have a primary care doctor that can manage your healthcare needs and refer you to specialists when needed.
  4. Exclusive Provider Organizations (EPOs) – This is roughly the same type of plan as a PPO. However, where a PPO or HMO organization may still pay part of the bill for a doctor outside of the network, this is not an option with an EPO. EPO plans do not cover any costs when you see a doctor or specialist that falls outside of their network. The upside of these plans is that they ask lower premiums than those that you will have to pay to PPO.

The different plans are very similar but differ in cost, choice of healthcare providers, amount if admin involved and whether you can see a specialist without referrals.

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What Do You Pay?

When you buy health insurance, you have to make monthly payments and possibly also some other contributions. Here is what you generally need to pay.

Deductibles – You may have to pay deductibles if your healthcare needs go beyond preventative care. You will also usually have to pay higher deductibles if you see a doctor that is not part of the network, except with EPOs which do not cover out-of-network providers at all. This is a payment that you have to make before the insurance company pays anything. Deductibles are annual fees and you will need to pay it every year.

Premiums – Your premium is the rate that you have to pay every month when you buy health insurance.

Copays– Copay is a fee that you must pay when getting care from a healthcare provider. It is usually a small fee that will be due by you. If your deductible has not been met yet, you will have to pay the full amount for a doctor’s visit.

How to Choose Your Insurance Brand and Plan

Some of the factors that you may need to consider when you choose your health insurance are:

  1. The costs – Compare the premiums, deductibles, and copayment requirements for different insurance brands and plans. Choose the one that suits your pocket. If you cannot afford a platinum plan with the most popular brand, then go for the next one that you can afford.
  2. The benefits – All insurance companies have to cover the essential health benefits for all their patients. However, you need to look further at the requirements for seeing a specialist. You need to find out whether they cover psychological healthcare services or therapists. Your personal health situation will determine what type of benefits you will need.
  3. The available doctors – You should request the list of network doctors and specialists that you can visit. Based on the list, you can find out which of the doctors and specialists are close to you and which ones will be too far to make it worth your while. This can be a big factor to sway your decision.

Choosing health insurance is a complicated process that requires doing your homework even if you have a broker. It is important that you understand the way it works, what is on offer, and what is expected of you as the client. Before making a decision, see what people are saying about the different brands and types. Always choose the options with the good reputation and happy customers.

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