Individual and Family Health Insurance
Individual health insurance programs are designed for individuals and families who cannot obtain health insurance through an employer. Due to the continually rising cost of medical care, it has become more important to provide health insurance for you and your family. Amber Insurance Services offers health insurance programs to individuals which offer extensive coverage as well as high-deductible programs which are designed to protect against catastrophic financial losses.
As an independent agency, we provide insurance plans from numerous health insurance carriers. With the health insurance market changing frequently, we are always looking for quality, service-oriented insurance companies for our clients.
Types of Health Insurance
Health insurance policies vary from low-cost to all-inclusive, meeting different demands of customers. Which health insurance type and plan one chooses depends largely on needs, preferences and budget. There are basically two (2) types of health insurance:
Fee-for-service is a traditional health care policy. As the name implies, insurance companies pay medical staff fees for each service provided to the insured patient. Fee-for-service health insurance offers a wide choice of doctors and hospitals. The ability to choose any doctor and change doctors at any time, as well as using any hospital in the country are some of the advantages of this type of policy.
Fee-for-service coverage falls into Basic and Major Medical protection categories. Basic protection deals with costs of a hospital room, hospital services, care and supplies, cost of surgery in or out of hospital, and doctor visits. Major Medical protection covers costs of serious illnesses and injuries, which usually require long-term treatment and rehabilitation. Basic and Major Medical insurance coverage combined is called a Comprehensive Health Care Plan. It is vitally important to know your insurance policy, since some services can be limited and some not covered at all.
The insurer does not pay all your medical bills. You pay a monthly premium and an annual deductible before the health plan starts paying part of the bills. After the deductible has been met, the bill is shared between the patient and insurance company. Usually, it is a 20%/80% split between patient and insurer. Proceeding with the payment of each bill’s percentage, you reach your plan’s maximum. This is the time when the insurance plan will pay 100% of the covered medical expenses for the rest of the year.
In order to receive payment for fee-for-service claims, forms, completed by either the patient or the doctor, need to be sent to the insurer. It is important to keep track of all medical expenses, such as receipts for medication, etc. If the main factor in choosing the health care plan is flexibility, and there are no strict budget limits, purchasing an Indemnity plan is recommended.
A Managed Care plan is the best option if minimizing costs is the primary goal, as the basic principle of Managed Care is to provide lower medical costs in exchange for more limited choice. There are three (3) types of Managed Care plans. The major differences between Managed Care and Fee-For-Service plans lie within two facts. First, the limited number of doctors and hospitals who participate in the managed plans. The second, significant aspect, designed to keep costs low, one’s chosen doctor is encouraged to supervise all services provided, and approval of a hospital or specialist may be required. This deprives the insured of the flexibility offered by indemnity plans.
The types of Managed Care plans include:
Health Maintenance Organizations (HMO)
HMO plans have an the advantage of low premiums. With an HMO, one selects a primary care physician to service health needs and generate referrals to other in-network providers, when required. This health care plan pays benefits only for doctors and hospitals within the HMO network. Coverage for out-of-network services is often provided only in the case of emergency.
Preferred Provider Organizations (PPO)
PPO is a combination of HMO plans and Fee-For-Service plans. Like HMOs, PPO medical treatment is fully covered if provided by a doctor or hospital within the PPO’s network. Insured individuals receive basic medical care and pay fixed monthly premiums. Using a PPO plan does not obligate the insured to choose a primary care physician and do not require referrals in order to see other specialists. However, to apply for medical treatment outside of the plan’s network, one will be paying more than people using health providers from within the PPO plan. Thus, with a PPO plan, one has the freedom to choose between paying more medical bills and an opportunity to receive medical services at a lower cost from network physicians.
Point-of-Service (POS) Plan
With a POS plan, one must choose a primary care physician (PCP) from within the health care network. The PCP can make referrals to other providers in the plan and outside the network. If the physician makes a referral outside of the network, the plan pays all or most of the bill. POS plan members can also refer themselves outside of the plan. However, in this case, your health insurance company will only offer a portion of coverage. A coinsurance payment will be required for medical services outside of the network. A POS plan offers more freedom than an HMO. Network care co-payments are quite low and there is no deductible. Paperwork for medical visits with the health care network is normally completed and submitted by the provider. However, there is a deductible for non-network care, and non-network co-payments are rather high. Employing doctors and services outside of the network, patients must complete forms themselves, and submit them for payment.
Other Types of Health Insurance Plans
When choosing the right health care plan, one may consider other, more specific types of health insurance. These other types usually serve particular consumer needs and may be cheap or costly, depending upon the policy. Some examples include Full Service Health Insurance, Catastrophic Health Insurance, Hospital Indemnity Insurance, Disability Insurance, Long-Term and Short-Term Care Insurance, etc. There are also the federal health insurance programs:
Medicare is a public health insurance program for American retirees aged 65 and over, as well as some disabled citizens.
Medicaid is a federal program that provides health care coverage for people with low income, the disabled and families with dependent children. Each state normally determines who should be covered by Medicaid and what medical services should be provided.