Health Insurance Facts

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Health insurance is primarily provided by the private sector, with the exception of programs such as Medicare, Medicaid, TRICARE, the Children's Health Insurance Program and the Veterans Health Administration. Comprehensive health insurance is a matter of economic security.


Coverage limits: Some policies only pay for health care up to a certain dollar amount. The type and amount of health care costs that will be covered by the carriers are specified in advance, in the member contract or "Evidence of Coverage" booklet. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.


PPO Plans (Preferred Provider Organizations) PPOs are another form of managed care, but provide more flexible coverage than HMOs. HSA (Health Savings Accounts) Plans are becoming more popular because of their low monthly premiums, major medical coverage, and a tax-free savings tool for health care expenses. In an HMO, health care is covered only for services delivered by providers (such as doctors or hospitals) in the network with whom the health plan has contracts. High deductible health insurance is a good option if you need a policy with a lower premium. High deductible health insurance is what makes health savings account such a great deal.


Cost and coverage are important, but do not just settle for "cheap" without making sure you actually have something that will pay the bills. Cost is often the primary factor for individual health insurance consumers, which is another reason why the benefits included in individual policies are often simpler. The purpose of very high deductible health insurance is that it can have extremely cheap monthly premiums.


Individual plans differ from group plans, which is the type of insurance that is offered through an employer. Individual consumers may be surprised to learn that some benefits that may be considered "standard 'in a group policy, like maternity coverage or substance-abuse treatment, may not be included in an individual plan.


Group coverage has a number of specific advantages over individual coverage, among them the following: Because a number of people can be included under a single contract, with consequent savings to the insurer in sales, administrative, and claims costs, the insurer can charge less per individual covered. Among those whose employer pays for health insurance, the employee may be required to contribute part of the cost of this insurance, while the employer usually chooses the insurance company and, for large groups, negotiates with the insurance company.


Health insurance is a major expense for many people, and sometimes it is difficult to see what kind of benefit you are really getting out of it. Comprehensive health insurance is a matter of economic security and it's an important component of a sound financial plan.

Source by Andy Movsesian