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What choices do I have in health insurance?

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What choices do I have in health insurance?

What choices do I have in health insurance?

Basically, you have two choices. 1) Indemnity plans and 2) Managed Care plans. These plans basically differ in 3 areas.

  • Choice of providers
  • How much you have to pay for services
  • How the bills are paid

Plan selection depends upon you and your priorities. There is no single plan that is best for everybody. You have to look around and find the plan most suitable for you.

Have a look at the various types of plans available to you - indemnity plans, managed care options and also Govt. sponsored health insurance.

INDEMNITY PLANS

Flexible spending plans or cafeteria plans allow the employee to choose. He can choose between various employee benefits available or cash. Flexible benefits include pre tax conversion plans, pre tax conversion plans with many options, medical plans and plans with employer credit. Get in touch with your employees benefit department to know more about these plans.

Under indemnity health plans, you can choose your health care providers. For a monthly premium, you can go to any doctor or hospital you want. The company pays your doctor for the services rendered. You may have to pay a part of the bills and a yearly deductible. There are often restrictions on covered services and you may have to seek permission from the required authorities before hospitalization.

Basic health plans give you limited insurance at a lower cost. Before buying such a plan, make sure you go into the details and then make a choice. Some of these plans do not even include basic healthcare measures, chemotherapy or maternity benefits. The premiums are fixed by community and so the rates might vary considerably. They are determined by your age, health profile and location.

Health savings accounts (HSA) are a comparatively new addition. You pay for current health expenses and save for future medical expenses on a tax free basis. You donít pay a premium. You establish a tax free savings account which covers your out of pocket medical costs. You decide the services on which you want to spend the money. You can also make investments with the money in the account so that it can grow. The only catch is that you usually have to buy a plan which carries high deductibles in order to sign up for HSA.

High deductible health plans (HDHP) are low cost insurance plans. However, they start only after a high deductible clause is met. This is usually about $1000 for a single person.

MANAGED CARE OPTION PLANS

Health Maintenance Organizations (HMOs) have a set network of doctors, physicians and hospitals. Once you have chosen a primary care doctor, he will co ordinate how your health care runs. He refers you to specialists if you need one. Usually, your expenses are lower. But you may often have to make co payments for visits to doctors and prescription medication.

You can also get Point Of Service (POS) plans. In these plans, the primary care doctor usually refers you to other service providers in the network. If the doctor refers you out of the plan, the company bears most of the costs. But if you go to a provider directly, you pay co insurance.

PPO or preferred provider plans charge you a fee for services. The charges for doctors, hospitals etc. are provided by the plan at a set price. If you use service providers within the network, your costs are less. You can go to a service provider outside the network, but then you have to pay the difference in costs.

GOVERNMENT SPONSORED HEALTH INSURANCE

In 1965, Medicaid was created as a federal and state sponsored assistance programme. It is given to people who cannot afford private insurance or healthcare. All states have these programmes but the eligibility and coverage varies.

Medicare is provided by the federal government for people over 65 and people with certain disabilities. The plan pays part of the hospitalization costs, surgery, doctorís bills etc.

State Childrenís Health Insurance Program (SCHIP) is another plan offered by state governments. The plan provides for healthcare of children whose parents can not afford healthcare.

Several plans are included among Military Health Plans. These include TRICARE (CHAMPUS) and CHAMPVA. Additional coverage is also provided by the department of veteran affairs.

State specific plans are also available for people having low incomes and those who do not have other insurance plans. They are known by different names in different states.

Indian health service (IHS) is also available to provide medical assistance to American Indians. They provide treatment at their own facilities as well as the cost for services out of their facility.

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