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.
Health insurance, just as with any other sort of insurance, is basically risk management. When you pay an insurance company their monthly fee–called an insurance premium–you are paying them to assume the risk of paying for you health care. The policy that you buy determines the benefits they will pay for should you become ill or injured. When you purchase health insurance, you purchase what is called a policy, which is generally a package of benefits, and the policy spells out the terms and conditions under which the company will pay.
When you shop for health insurance, you discover that there are many different kinds and packages. For many people, health insurance means a coverage that pays the bills for doctor visits, outpatient hospital care, and inpatient stays. However, there are other kinds as well, such catastrophic health coverage, maternity coverage, and dismemberment insurance to name just a few examples. When you search for health coverage, you find an assortment of plans each offering its own package of benefits with its own rate of payment. The insurance plan is the “package” of benefits, and the benefits describe exactly what the insurer will pay for. For this reason, it is important that you understand the package so that you know what to expect when you receive health care.
Some of the kinds of insurance plans most commonly sold are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee for service plans (PFFSs). The HMO, PPO, and PFFS are different ways of packaging benefits. That means that each kind of plan will pay for different kinds of services and each plan will have different payment rates. A payment rate is how much they will pay health care providers for their services. HMOs are usually less expensive but generally require you to get all of your care only from providers in the plan’s pre-determined network of doctors and hospitals. In an HMO you would be assigned a Primary Care physician, and a referral from that doctor would be required in order to see a specialist. Quite often, HMOs work better for individuals who in relatively good health and whose medical needs are not terribly demanding.
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.
Another common sort of managed care plan is the private fee for service plan (PFFS). The PFFS has no pre-established network of doctors and hospitals and leaves your choice of provider up to you. It is important, therefore, that your doctors agree to accept the plan’s payment terms, and that you find out before you receive services if you doctors submit claims to the insurance company. Rather than offering you a fixed package of benefits, as is the case in an HMO or PPO, your providers bill the PFFS a fee for each service you receive, and the PFFS pays for each service according to its fee schedule, or payment rate.
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.
You can find cheap quotes for health insurance, but the key to a low cost plan is in coming as close as you can to paying only for a relatively few number of key services. In other words, if possible, you strip the policy of every service you can possibly do away with and assume as high a deductible as possible. Also, you must verify the reliability of the company because it’s important that they pay promptly and without argument should a time of need arise.
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