How health Insurance Works

How health insurance works - How to find the best, low cost health insurance plan? I can't tell you how important it is to do your homework, and in this article I'll try to help you with some of that homework. You might think health insurance is all the same, but the devil is in the details and understanding the details may save you hundreds of dollars.

how health insurance works - When you buy health insurance, just as with any insurance, you are paying the company a monthly fee (insurance premium) to manage the risk of your need for health care coverage. The more risk the company assumes, the greater the premium. However, you as a consumer, must understand what you are paying for, and you also have to be your own watchdog to some degree and pay attention that you get what you pay for. At its basic level, health insurance is the assumption of risk on the part of the company.

Health insurance comes in many different forms. For example, there is disease insurance, accidental death and dismemberment insurance, catastrophic health coverage, COBRA insurance, and maternity coverage to name just a few examples. All of these, by the way, are kinds of health insurance. When you shop for health insurance you are generally presented with a variety of plans that offer different benefits and and different levels of coverage. Insurance plans are the way the insurance is packaged. The plan is the "bottle" holding the wine, as it were.

Some of the more common kinds of health insurance plans are the Health Maintenance Organization, or HMO; the Preferred Provider Organization, or PPO; and the Private Fee for Service Plan, or PFFS. HMO plans are generally less expensive, but they required that you use only the doctors, hospitals, and other health care providers who have a contract with the insurance company to provide service. You are usually assigned a primary care doctor and must get a referral to see a specialist. The plan ultimately determines whether or not you can see a specialist and what services and how many of each service you may receive. If you are in relatively good health and have relatively few medical needs, an HMO might work out for you. If you have a more complicated medial history, you would want to thoroughly investigate the insurance company and specific HMO to be sure they have a reliable record of meeting patients coverage needs. Kaiser Permanente would be an example of a well reputed HMO, and Kaiser Health Care generally has a good reputation throughout the United States where it is offered.

The PPO is more flexible than the HMO plan. PPOs may also be a bit more expensive than HMOs, and that is because PPOs are generally thought to give a higher level of coverage. In PPOs, you are not required to have a primary care doctor, and you generally do not need a referral to see a specialist. PPOs have their own network of contracted medical personel but allow you to go out of the network to see doctors of your own choosing. Now, that costs you more. That means the company provides a lower level of coverage (payment) and make up the balance. Before signing up for a PPO, it is important that check with your providers to determine whether they are in the network or will otherwise file claims and accept payment from that particular insurance company. Major insurance companies such as Aetna and Blue Cross Blue shield, Wellmark Blue Cross, and Humana offer PPO plans as well as HMO variants.

A PFFS plan is still a kind of managed care, but in the private fee for service plan, you go to any doctor or hospital you choose as long as they submit claims to to insurance company and accept payment. In a fee for service plan, your health care providers would bill the insurance company a specific fee for each service provided. What the insurer pays is based on a fee schedule.

When you buy a health insurance plan, the actual cost of the plan is not only the price of the premiums, deductibles, co-pays and co-insurances. When you figure the real cost, you must also take into consideration the reliability of the company in living up to their promise of coverage for the kinds of services that are important for you and your family. Thus, a "cheap" plan could end up costing you more if the company doesn't cover the costs specified in the policy. Humana, for example, may offer you less expensive plans, but if you have to argue with them over meeting the basic agreements in the policy, then the coverage would be useless and the cost to you far greater than you had imagined.

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.