Navigating the Insurance Landscape
Health insurance is an integral part of everyday life for Americans. Not only is it essentially mandatory, but it is also virtually unaffordable to receive medical care in today's economy without some time of health insurance. Some options to look at include AARP, a nonprofit organization that provides advocacy, resources, and services for individuals aged 50 and older, and UnitedHealthcare, a prominent health insurance company that offers a variety of healthcare plans, including Medicare Advantage and Medicare Supplement plans, providing comprehensive coverage for the aging population, often in collaboration with AARP. Here's how to get health insurance.
Less Favorable Medicare Coverage Plans
Some plans may be perceived as less favorable due to high out-of-pocket costs, limited coverage, or specific restrictions. Medicare Advantage plans with narrow provider networks or those with high copayments and deductibles might be considered less comprehensive.
Additionally, stand-alone Medicare Part D prescription drug plans with limited formularies or high premiums could be seen as less cost-effective. It's essential for individuals to carefully review plan details, considering factors such as coverage breadth, network accessibility, and overall cost, to select a plan that aligns with their specific healthcare needs and budget.
Types of Health Insurance Plans
Health insurance plans can be broken down into two broad categories: traditional and managed care. Each of these two categories has various subcategories. Most health plans can be purchased through the healthcare marketplace online after answering a series of questions. Depending on how many plans are offered where you live, you may find plans at a variety of different levels indicated by metal colors platinum, gold, silver, or bronze.
Some plans restrict your choices of provider or encourage you (through higher fees or co-pays) to use providers within the plan's network of doctors, hospitals and pharmacies. Depending on the needs of your family, some of these restrictions may add complications to seeking treatment for your children in specialty settings. It is essential to carefully review what is and what is not covered by each plan at each level to determine which plans will meet the coverage needs of your family.
The most common plans you will find on the marketplace are:
- Traditional indemnity plans.
- Preferred Provider Organizations (PPO).
- Point of Service plans (POS).
- Health Maintenance Organizations (HMOs).
One plan is not necessarily "better" than the other. The plan you choose will depend mainly on the needs of your family and your individual preferences.
Up until about 30 years ago, traditional plans (indemnity plans) were the plan of choice for most people. Today, these are known as fee-for-service plans. Indemnity plans are a bit like auto insurance. You pay a certain amount of your medical expenses upfront in the form of a deductible, and afterward, the insurance company pays most of the bill. Under this type of plan, you have complete control over which doctors and providers you see.
The downfall to these plans is they often have a higher out-of-pocket expense in the form of deductibles, which need to be covered before the insurance will start to pay. In short, fee-for-service coverage offers flexibility in exchange for higher out-of-pocket expenses, more paperwork and higher premiums. With advances in modern medicine and the associated lengthening of human life spans, insurance companies began to look for ways to reduce cost and managed care was born.
Managed Care Plans
Managed care, in some form, has been around for decades, but it only began to gain traction in the last decade or so. As it grew and changed, we were left with three types of managed care plans.
Preferred Provider Organizations (PPOs)
PPOs have contracted for lower fees with a network of healthcare providers. They often have a financial incentive to stay within a specific group of providers. With a PPO, you can refer yourself to a specialist without getting approval and, if it is an in-network provider, enjoy the same co-pay. Staying with the same group has many benefits, such as less fees. Be sure to check if preventive care services are covered under a PPO, because in some cases, they may not be.
Point of Service (POS)
Point of service plans are like PPOs, but they include the requirement of a primary care physician (PCP) who will need to be chosen from the plan's network of providers. As with the PPO, you can choose to go out of the network and still get coverage, but it will come at an increased cost. To get a referral to a specialist you might need to go through your PCP. You can refer yourself, but it will likely cost more money. Again, be sure to check if a POS plan covers preventive care services or not.
Health Maintenance Organizations (HMOs)
HMOs are a type of health insurance plan that usually limits coverage to care provided by doctors who work for or contract with the HMO. Having an HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
The above lists do not cover Medicare or Medicaid plans. These plans have specific qualifying criteria and cannot be "bought" through the healthcare marketplace or employer-sponsored programs, as other types cannot.
Qualifications for these plans are based on age, work history, financial status and medical need or disability.
Four Easy Steps to Obtain Health Insurance
Evaluate your needs
Take the time to evaluate the needs of yourself and your family. Be sure to consider what your current healthcare needs are and what you could need in the coming year.
Consider the following things during this evaluation process:
- The amount you spend on medical expenses every year.
- The cost of medications you use regularly.
- Your budget.
Learn About Available Options
Before making any decisions about your health insurance and which plan to enroll in, it is essential to understand the differences between the major types of insurance. Refer to the above information to help distinguish between the various types of plans. Also, note the "metal color" of the plan being offered. The more expensive the metal, the more perks are included in the plan. Thus, an HMO platinum plan will likely have more frills and perhaps more cost savings than the same HMO bronze plan.
Also remember, when it comes to annual or monthly plan costs, HMOs generally have less expensive monthly premiums. PPOs usually have higher premiums, but the more expansive premium affords you the option of using any doctor without needing a referral.
Request a Quote
After you have finished your research and determined your specific healthcare needs, it is time to start shopping for a plan. You may want to consult a licensed insurance agent for assistance, or you can obtain quotes from various websites.
Many of the market plans do not automatically include dental or vision plans, so if you are interested in those, you will need to research availability or check the appropriate boxes on the healthcare marketplace qualifying questions page.
Enroll in a Health Insurance Plan
Once you have determined which plan meets your needs and found the best plan for you, it is time to enroll. Once you have paid your initial premium payment or set up payment plans as required, you will receive confirmation of your enrollment and your insurance cards.
UnitedHealthcare is a prominent and widely recognized health insurance provider in the United States, known for offering a diverse range of healthcare plans and services. As a subsidiary of UnitedHealth Group, one of the largest healthcare companies globally, UnitedHealthcare plays a significant role in providing comprehensive coverage to individuals, families, and seniors. With a commitment to quality care and a vast network of healthcare providers, UnitedHealthcare continues to be a key player in shaping the landscape of health insurance in the United States.
AARP is a prominent nonprofit organization dedicated to addressing the needs and concerns of individuals aged 50 and older. With a membership base of over 38 million people, AARP plays a crucial role in advocating for the well-being and quality of life of older Americans. Beyond its advocacy work, AARP provides a wide array of resources, including educational materials, community engagement opportunities and member benefits. AARP collaborates with various partners, including insurance providers like UnitedHealthcare, to offer specialized products and services, particularly in the realms of health and financial security.
Millions of people are in deep debt due solely to medical bills they are unable to pay out of pocket. This is not to say that health insurance is always affordable. Unfortunately, it can be quite costly as well, especially if you cannot benefit from employer-provided plans. For example, having a baby.
A "normal" pregnancy and delivery without complications can cost anywhere from $5000 to $11,000 after insurance contributions. A "normal" pregnancy without insurance can produce bills over $30,000 for a vaginal delivery and over $50,000 for a C-section. The birth of a child is just the beginning of the potential medical bills your family can face. This makes insurance an essential element of your everyday life.
Looking for health insurance can be overwhelming. By dividing it into four simple steps and carefully considering the needs of your family, the process will be easier to understand. Once you are enrolled, you can relax and enjoy the peace of mind associated with having health insurance to cover your needs. Knowing you and your family are protected for current and future needs can bring about security and confidence that is worth the time and effort associated with the process.