What is the truth about health insurance? Is it possible to find low cost health insurance? The truth about finding low cost health insurance really depends on your understanding of a few key basics. Many people think that health insurance is all the same, but that is not true and making that mistake can cost you money. In this article I will try to help you understand some of the key concepts underlying present day health insurance.
One of the first things to understand is that when you purchase health insurance, just as with any kind of insurance, you are purchasing a sort of contract that guarantees you a specific set of benefits. In order to remain eligible to receive those benefits, you pay a recurring, monthly fee which is called a premium. The premium is the insurance company’s fee for managing the risk of your need for health insurance coverage. At bottom, all insurance is risk management, and you are essentially paying the insurer to assume the risk of payment for health care.
Health insurance comes in many different forms. For example, there is disease insurance, accidental death and dismemberment insurance, catastrophic health coverage, COBRA insurance, and maternity coverage to name just a few examples. All of these, by the way, are kinds of health insurance. When you shop for health insurance you are generally presented with a variety of plans that offer different benefits and different levels of coverage. Insurance plans are the way the insurance is packaged. The plan is the “bottle” holding the wine, as it were.
Some of the more common kinds of health insurance plans are the Health Maintenance Organization, or HMO; the Preferred Provider Organization, or PPO; and the Private Fee for Service Plan, or PFFS. HMO plans are generally less expensive, but they required that you use only the doctors, hospitals, and other health care providers who have a contract with the insurance company to provide service. You are usually assigned a primary care doctor and must get a referral to see a specialist. The plan ultimately determines whether or not you can see a specialist and what services and how many of each service you may receive. If you are in relatively good health and have relatively few medical needs, an HMO might work out for you. If you have a more complicated medical history, you would want to thoroughly investigate the insurance company and specific HMO to be sure they have a reliable record of meeting patients coverage needs. Kaiser Permanente would be an example of an HMO, and Kaiser Health Care generally is generally well-known throughout the United States.
The PPO offers more latitude than an HMO. The PPO also includes a network of providers for plan members, but PPOs allow you to go out of the network for coverage, though going out-of-network is usually more expensive. The costs of PPO membership–the premiums you pay, for example–are generally more expensive than HMOs, but the level of coverage is often greater. PPOs do not require referrals to see specialists, though you do want to be sure that out-of-network providers accept the insurance and therefore accept the company’s payment rate. Examples of national insurance offering PPO plans would include Anthem Blue Cross, Humana, Aetna, Cigna, Tonik, and Wellmark.
A private fee for service plan (PFFS) is yet another kind of managed care. However, this sort of plan does not require you to receive care from a network of providers. In the PFFS plan you can receive care from any doctor, hospital, or other health care provider who accepts the plans payment terms. It is advisable that you always check with your providers first before receiving services to be sure that they will, in fact, submit claims to the insurance company. In a PFFS, instead of offering a package of fixed benefits (as in an HMO and PPO), the company pays a set fee for each service you receive that the provider bills to the insurer.
An important question you want to ask before buying a health insurance policy is how much your costs will be. Much of the cost of a plan will include the monthly payments (premiums) along with any deductibles, co-pays, and co-insurance. However, there is another cost to take into consideration, and that is the reliability of the company. It is important that the company live up to its promise of coverage. This is a fairly controversial issue right now and another reason to taking the time to understand the policy before you buy. A plan that looks cheap could end up costing a lot more than a more expensive plan or a different plan from a different insurance company.
It is possible to find cheap quotes for health insurance, but the secret to getting a low cost plan lies in paying only for the key services you need. Basically, then, you want to remove from a policy every benefit you can do without and then assume as high a deductible as possible. And again, you want to undertake the due diligence to establish the company’s reliability. In a time of need, it is vital that the insurer pay in a timely fashion without argument.
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