BLOG SECTION

10 Reasons For Personal Health Insurance

10 Reasons For Personal Health Insurance

Heath care costs are the main reasons people are worried when they get sick. And that should not be the case. People who get their health coverage through a company they are an employe of, are quite safe, but there are some health issues that are not covered by this type of coverage, and that can be a big problem. So here are the main reasons you should think about getting yourself a personal health insurance.

The insurance you get from your company does not suit you

http://winhealthpartners.org

Group health cover is something you will get when you are an employee, but that coverage can be so complicated and basic that can only create more problems than it can solve. If you have some expensive costs regarding your health care this is usually not covered by your group health coverage. This type of coverage is often not extended to your family members wich leaves them uncovered (your parents, partner, children). It is often the case that the person needs to pay quite extra to get his/her family members covered as well.

If your job transitions are quite often

We live in a time where having one job for one company for a whole life is quite impossible. And the problem is that people get sick and need medical attention when they are out of work, too. If you had group health coverage through your company, and now you are searching for another job, the fact is that you have no health care insurance through that period. Being unemployed can last from month to entire year and any medical attention you may need during that period will leave you dry if you don’t have any medical insurance. That is why it is a good option to have a personal medical insurance that covers you and your family members even when you’re on your next job hunt.

Saving your money

Realistically, any health care cost is barely affordable, but your health insurance will always be affordable to you. Choose a health plan that will have your back in case of emergencies, flu, stress-induced diseases, or when there is immunization of population. Health care costs are rapidly getting higher each year.

Taxes

If you have a personal health insurance, that will help you save taxes because personal, family and senior premiums can be filed for tax exemptions. Depending on your coverage plan and level you can also have a health account which can pay for your expenses tax-free. Choose your personal health plan carefully in order to suit your personal needs and the health needs of your family. There are a lot of options and honestly, every one of them is better than basic company coverage.

Catastrophic Health Insurance

Catastrophic Health Insurance

This is a medical coverage that is suitable for people who are under 30 years old. It is a high deductible plan that is specifically designed to protect its members in worst-case scenarios. Examples are medical emergencies or medical costs which total is thousands of USD dollars. This monthly plan has lower premiums, but you will be paying all of your costs out of your own pocket until you reach your plans annual deductible, and that is usually a couple thousand of dollars. In this article, we will give you an overview of this coverage, how it works, and what are the benefits.

Benefits you should know of

This healthcare plan covers just the same minimum of benefits as other plans, and those are prescription drugs, emergency services, preventive services and more. The main difference with this plan is that you are paying all the cost of your annual deductible.

http://winhealthpartners.org

The costs that you catastrophic health plan will cover, even if you haven’t fulfilled your deductible yet are three visits to the doctor every year, all the free and preventive services that are under Affordable Care Act, which includes certain immunizations and screenings. Copayment and coinsurance are a little bit higher than with other plans. But your monthly premium is lower. This coverage is quite different from short-term plans, critical illness or accident because those types are protecting policyholder just in limited specific situations that can occur. With this plan you can choose which doctors will provide healthcare for you, the important to remember is that they need to be in your network.

What are you paying through this plan

As we said, the monthly insurance premium is lower than with other healthcare plans. A deductible is a little over seven thousand dollars for an individual or fourteen thousand dollars for a whole family. But after you reach your deductible, this plan will cover your costs 100 percent. Paperwork is involved and you may need to keep a close eye on all of your expenses regarding medical costs.

What if you are over 30

http://winhealthpartners.org

If you are still interested in this health plan, check if you can qualify for an exemption from hardship. Those exceptions include people who are homeless for at least three years, or if you are not eligible for Medicare in your state because of states’ mistake. There is also an exemption if you have financial difficulties.

Point-Of-Service Plan (POS)

Point-Of-Service Plan (POS)

 There cane be a lot of confusion with Point-of-Service Plan (POS), so here are the main things you should know.This healthcare plan coverage is quite a hybrid between Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Just like the HMO, this plan offers you the primary care provider from its network. The difference is that POS will, just like PPO offer you a possibility to seek the help from outside your network of providers but you will be needing to pay most of those costs – unless your primary care provider referred you to that specific provider that is out of your network. So, in case of emergencies and in case of referral, your POS medical plan will pay your bill.

http://winhealthpartners.org

Most people choose either PPO or HMO plan, regardless of the fact that POS offers the best of both worlds. This is somewhat to the fact that POS plan is not marketed so aggressively as other plans. The premium you need to pay for POS is somewhere between the higher PPO premiums and lower HMO premiums.

How does POS plan works

So, in short, with POS healthcare plan you will get more of that desired freedom to choose your own health care provider, just like you can do it with HMO. There is a moderate amount of paperwork you will need to fill out if you see a provider (doctor, specialist, hospital) that is out of your POS network. You can choose your primary care doctor and he will coordinate your care through your life and will refer you to the specialists you might need. In this way, you will make a personal connection with your physician as he monitors your health through your life and is familiar with your medical history. But, you can still see any doctor you want. If that doctor is in your POS network, the charge will be covered, but if it is not, you will need to pay a little more than usual.

What you need to pay for your POS

In order for your POS to start covering your healthcare, you will be needing to pay a deductible that can be higher for providers that are out of POS network. Here you do not pay copay and coinsurance, you just need to pay one of those. Copay is paid when you receive care, and coinsurance is the percentage of the charges for your care. Percentage variates depending on the level you are (bronze, silver, gold, platinum), where the percentage you need to pay can be 40, 30, 20, or 10 percent. Of course, copay and coinsurance are higher when you use a provider that is not part of your network.

 

Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

This health care insurance plan is a hybrid. Trough EPO health services can be covered only if you seek help from hospitals, specialists, and doctors that are in your network. Of course, like in other plans, this is not valid in case of an emergencies like trauma accident or child delivery. Any other visits to healthcare providers that are out of your network must be pre-authorized because out of network help is not provided.


Differences between EPO and other plans

EPO is different from HMO in a way that Health Maintenance Organization pays a monthly fee to your healthcare provider regardless of the fact that you visited or not visited doctors that month. Exclusive Provider Organization pays only the service you acquired when you acquired it. Here you also don’t have to choose your primary care physician. EPO offers you more freedom than HMO because here you can choose who your health care providers will be. There are no coverages for providers out of your network, so you will have to pay the full cost. But Exclusive Provider Organization has a lot lower premium and you can see any doctor you wish that is in your network.

http://winhealthpartners.org

There is almost no paperwork that needs to be filled with this type of health plan. Copay is paid after you get the care you need and it is a flat fee, somewhere around fifteen dollars. Coinsurance will variate depending on your insurance level (bronze, silver, gold, platinum), and can be from 10 to 40 percent. Not all EPO plans have a deductible but some might have.

How EPO combines the best from PPO and HMO

The good thing with Exclusive Provider Organization is that it combines all the flexibility there is in Preferred Provider Organization (PPO) plan because here you are not in need of a primary provider of your healthcare and can use anyone in your network. EPO is also really cost friendly just like Health Maintenance Organization (HMO) plan. Exclusive Provider Organization plan is quite recommended because of the advantageous package that it has over other healthcare plans.

Preferred Provider Organization (PPO)

Preferred Provider Organization (PPO)

 With his healthcare plan, you will be connected with specific medical providers, doctors, hospitals, and all other health benefits that are connected to this network. If you are using those providers for your healthcare you will be paying less. You can, of course, use providers, hospitals, and doctors outside your network but that can lead to some additional costs.

What you get with this plan

PPO offers you moderate freedom regarding the choice of your health providers, and in that way, it is better than HMO. Also, you do not need to visit your primary care doctor every time you want to see a specialist, it can be done without a referral. You can seek medical attention from doctors that are not in your network but it will cost you more. The amount of paperwork if you see out of network doctors is bigger compared to other plans. There is a reasonable fee schedule that is used for claims that are out of your network, and if they are exceeding reasonable fees for specific service, the coverage will fall on a patient.

http://winhealthpartners.org

PPO has a higher premium than other plans, but it also gives you more flexibility. The network is quite large and there are providers in numerous states and cities. The possibility you will be in need to seek help from someone out of your network is quite small. You can always choose your provider. This type of plan also cover and manage programs regarding your healthcare that is often excluded in other coverages or is charged additionally. This coverage is preferred among employers.

What you will be needing to pay

Not all PPO plans have a deductible, but it is quite likely that you will have to pay a higher one if you seek help from someone that is out of your network of providers. If the provider that is out of your network charge you more than others in that same area, you probably will have to balance that out. There is some paperwork for providers out of your network but for those that in PPO network there is no, or quite a little paperwork you need to fill. There is copay that you will have to pay after receiving care and it is a flat fee. There is also coinsurance, meaning you will have to pay some percentage of your charges, depending on your plan level.

All Types Of Health Plans There Are

All Types Of Health Plans There Are

When you choose your new health insurance it is important to be well informed about options you have and which type will suit you most. Health coverage can be bought from an insurance broker, company or states Marketplace. They are organized by benefits they offer, which translate into levels such as platinum, gold, silver, and bronze which is the most basic and cheaper one. If you have under 30 years of age, you can also apply for a catastrophic high-deductible plan.

http://winhealthpartners.org

These plans can be quite different in a way that each of them pays a share of costs that is set in advance, and all the details are different depending on that specific plan. Also, the amount you need to pay even before your plan starts to be effective, and that is called deductibles, variate a lot from least to highest expensive and deductible.

 

Levels of your healthcare plans:

 

A platinum plan should cover 90 percent of your medical costs, meaning you need to pay only 10 percent of them. A gold plan will cover 80 percent, silver 70 percent, and bronze will cover 60 percent of your costs which means you will be needing to pay 40 percent of your medical costs. Catastrophic policies are covering less than 60 percent, and a catastrophic plan also cover your first three primary care visits, and preventive care – all for free.

 

Types of your health insurances:

 

It is quite important to choose a plan that will be suitable for your health care needs and wishes so you can be protected in a way that you can benefit the most. Each insurance company offers some of the types of plans, but we offer all of them.

http://winhealthpartners.org

Those plans are:

  1. High-deductible health plans (HDHPs), that can be also linked with your health savings accounts (HSAs)
  2. Point-of-service (POS) plans
  3. Exclusive provider organizations (EPOs)
  4. Preferred provider organizations (PPOs)
  5. Health maintenance organizations (HMOs)

 

When you get familiar with these types of healthcare plans you can easily determine which one will fit the best with your needs and your budget.

Health Maintenance Organization (HMO)

Health Maintenance Organization (HMO)

 This insurance plan is made in a way that it will usually limit your coverage care from specialists and doctors who are working for or have a signed contract with the Health Maintenance Organization. This health plan will not usually cover your bills if you sought help from someone that is out-of-network. The exception is if that care was an emergency. In order for you to be eligible for this kind of coverage, it may be required of you to work or to live in an area that is covered with this type of service. This is to avoid you seeking help from someone who is not covered by this type of your health plan. HMO is used for wellness and prevention of diseases.

http://winhealthpartners.org

The good and not-so-great sides

Disadvantages with HMO is that trough this plan your freedom to choose any health care provider you want is quite limited, and in order for you to see any kind of specialist, you will be needing to first see your primary care doctor and get a referral from him.

Advantages of HMO plan are that if you are in a good health this type of healthcare plan may be all that you need. This plan also has the least amount of needed paperwork, and you are free to seek help from any doctor that is on your network. If you see someone out of your network through the referral of your primary care doctor, these expenses should be covered as well.

What you need to pay

http://winhealthpartners.org

There is a possibility that your plan will require you to pay a specific deductible amount before it can cover your health. But after that, this plan will pay 100 percent of your charges. You won’t be needing to fill any claim forms but some paperwork is involved. After getting a specific care you will be needing to pay copay that is always a flat fee and is something around 15 dollars. There is also coinsurance that you will pay, but it varies according to the level of your plan and can be something like 20 percent for example.