Health Insurance

What is health insurance? | Insurance Types | What is not health insurance?

Insurance is a means for people to receive health care with someone (typically an employer sponsored program) paying for all or part of the medical services provided through monthly premiums to a third party. Those who cannot get insurance through an employer purchase individual policies (usually relatively expensive), are covered by Medicaid if eligible (based on lower income levels), or with Medicare, designed for the elderly. The remainder have no insurance at all (and this element of Americans continues to grow exponentially).

Due to the passage of the Affordable Care Act (Obama Care) the health insurance industry is changing. The consumer needs to consult with a certified licensed professional to learn the truth about the law and how it will effects them.  There are many good points about the law such as: guaranteed issue, no preexisting, children covered till age, wellness, physical and mental health therapy, maternity etc. and they are some issues but the good far outweigh the bad. Now the law must be tweeted to better serve the overall system.

Health InsuranceWhen contracting for health insurance, the purchaser and the insurance company create a legal and binding agreement between the two parties. The contract stipulates what will be paid on the member’s behalf and what won’t. Unless it is a managed care policy (HMOs, PPOs), the contract stipulates that when medical care is received;

  • the member (insured party) must submit the claim
  • when the claim is to be submitted
  • where the claim is to be submitted
  • how much will be paid by the insurance company
  • member deductible, copayments

The provider in the above example is not a party to this contract. It is between the insurance company and the individual who pays the premiums.

The following are some different types of plans available:

  • Managed Care
  • Health Maintenance Organization
  • Preferred Provider Organization
  • Point of Service Plans

BEFORE YOU MAKE ANY DECISIONS:

It is best to sit down and review your needs, review your financial situation, and perhaps contact one or more insurance agents or brokers, and ask them to help you evaluate all the options, so that you can decide which of all the available options best suits your needs.