How to Get Health Insurance
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.
There are millions of people who 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.
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 market place 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 health care 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 plans 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 HMOs 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.
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.