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.