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Health insurance coverage can be very confusing. The majority of
Americans are able to get some sort of group health coverage
through their employer, which makes the process very simple. Do
you want the coverage or not? Yes, I want the coverage. But for
the rest of us, we have to search, fill out forms, compare 20
companies, compare 100's of plans and get extremely disgusted
with the process. Do you really know what youýre comparing?
Here's some help.
Comparing health insurance companies. Look for companies you
know. There are 100's of fly-by-night companies out there trying
to rip people off. Companies like, Blue Cross, Aetna and Humana
have been around for many years and will be around when you need
them.
Comparing health insurance plans. Do you know the difference
between PPO (preferred provider organization) & HMO (health
maintenance organization). A PPO is a network of doctors that
accept a particular insurance plan. With a PPO, you have
in-network and out-of-network benefits. Basically you have
better cover in-network. You can see any doctor in-network at
any time without needing a referral. On the other hand, with an
HMO you will need a referral to see any other doctor than your
primary physician. Conclusion, you have better control of your
healthcare with a PPO plan. Also, there are not very many HMO's
left. Most companies only offer PPO plans.
Comparing health insurance benefits. Deductible, doctor copay,
coinsurance, prescription copay, there are a lot of different
options. This is the simplest way to explain it. When you go to
the doctor, you pay your doctor's office copay. This is the same
for prescriptions. Any services done out-side of the doctors
office like lab work, x-ray and outpatient surgery are not
covered under the copay. Your deductible is per member per year.
So, everything that is not covered by the copay, you will pay
out-of-pocket until you meet your deductible. Then you pay your
coinsurance, usually 20-30%. Once you meet your coinsurance
maximum, the company will pay 100%. Your coinsurance maximum is
usually 3 times your deductible.
It sounds like you are not get very much benefit form the
insurance, but you have to remember what insurance is really
intended to do. Insurance is intended to protect you, in the
event of a catastrophe, from losing your life savings or filing
for bankruptcy.
My personal advice is, and this is what I tell my clients...Get
a health insurance policy that you can comfortably afford. If
you are in good health and never go to the doctor, get a higher
deductible plan with limited doctor's office benefit. If you are
in poor health, or you have a young child that goes to the
doctor often, get a plan with a lower deductible and better
doctor's office benefit. Sound like common sense right? Well, it
is. You need health insurance coverage, so get something you can
afford and trust.
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