This section will cover all of the health insurance basics you need to know to get started choosing the right health insurance plan for you.
When beginning to look into health insurance options, the entire process can seem overwhelming. Even the vocabulary used to talk about healthcare and medical insurance is unique and takes some time to get used to. It is important to understand these terms in order to make sense of the different types of healthcare plans available to you.
There are multiple types of insurance policies that range in coverage options, choice of provider network and out-of-pocket costs. All types of plans are not available to everyone in every location. Some are intended for specific groups while others are available to the general public. If you are shopping around for health insurance for more than just you, you should pay special attention to family health insurance plans. Learn about who can be included on a family health insurance plan, average costs for these plans and the many benefits of choosing this plan for multiple household members instead of buying several different health insurance plans. Being familiar with this information should give you a much better idea of how to figure out which health insurance plan is right for you and your specific needs.
Understanding health insurance terms will provide you with the basis for being able to thoroughly understand health insurance policies. This section is divided into four sub-areas, and each one covers a different aspect of important health insurance information. This sections start by defining basic terms used to talk about recent healthcare regulations, such as what ACA is and what it means to incur a penalty for going without insurance. This vocabulary will help you start to understand how healthcare is structured across the United States.
For many people, the next sub-section in this article may be the most important. It goes into more detail about the common terms used to describe the costs associated with healthcare plans. Beginning with the basic definition of the various types of out-of-pockets costs associated with health insurance plans and moving into more specific terms like the “allowed amount” insurance providers can ask policy holders to pay. From here, you can continue on to delve into vocabulary about some of the most important elements of healthcare policies. Principal terms describing health insurance elements that can significantly affect how you take advantage of your policy will be covered, like pre-existing condition.
Health insurance plans come in many shapes and sizes. The health plans that will be available to you will depend on your geographic location and what insurance providers are operating in your area. There are six primary types of health insurance plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Exclusive Provider Organizations (EPO), Point-of-Service Plans (POS), High-Deductible Health Plans with or without a Health Savings Account (HDHP/HSA) and Fee for Service (FFS) programs.
Understanding the basic structure of each plan type will help you be better informed as to which plan will best suit your needs. Information concerning the type of provider network used, whether you need a referral from a primary care doctor or not to see a specialist, premium and out-of-pocket costs and much more is reviewed for each of the six basic insurance plan types.
In addition to the most important information about the substance of each program, this section also reviews the different types of coverage levels that can be purchased for most insurance plans available through your state marketplace. These coverage levels include catastrophic, bronze, silver, gold, and platinum options that cover from 60 to 90 percent of total healthcare costs for program beneficiaries. This section also includes relevant program pricing information, especially in regards to how the price of the plans compare to one another and what the beneficiary’s most likely out-of-pocket cost will be. While not all plans may be available to every individual looking for health insurance plan options, more than one option is guaranteed to be provided to every person shopping for insurance at through their state marketplace. Some individuals may have the option to choose other, less common types of health insurance plans as well.
Many families searching for a new health insurance plan may not be aware of the savings that can be had by opting for a family health insurance plan. While plan beneficiaries without any dependents should continue looking at individual plans, those individuals who are part of a household with others who also need insurance should make sure to take a look at any family health insurance plans they may qualify for. Family health insurance plans are generally offered by the same insurance providers that offer private insurance plans.
The difference between individual and family health insurance plans is the number of beneficiaries associated with the plan. Most family health plans permit the primary beneficiary to add up to five other family members onto their account, though more family members can often be included if they meet the necessary requirements.
With a few exceptions, insurance providers generally consider any household members that you claim as dependents on your tax returns to be eligible to participate in your family health insurance plan. Make sure any family members you would like to add to the family plan do not already receive health insurance from another source and are included in the list of eligible beneficiaries. Choosing to opt for a family health insurance plan instead of several individual health insurance plans for your family will save you an incredible amount of time and effort. In many cases, insurance providers will also include different spending limits on family insurance plans so that you may even be able to save significantly on your out-of-pocket costs for the family on the whole by opting for the group plan.
To figure out which insurance plan is right for you, it is important to begin thinking about your medical priorities and any limitations you my face, like those brought about by a pre-existing condition of a very tight budget. This section points out the most influential differences among six of the most common health insurance plans available on the state marketplace. Many aspects of the healthcare plans available on your state marketplace today are the same across all programs because they are the result of regulations from the Affordable Care Act (ACA). For some people, many of these differences may be inconsequential when it comes to how they will choose which health insurance plan is right for them. For others, however, these differences can make a health insurance plan go from being perfunctory to actually useful.
If you are not sure what is your priority when it comes to choosing the right health plan for you, take a look at all of the differences among the programs reviewed in this section. You may find that a variation in how a health insurance program deals with out-of-network medical providers and facilities compared to its in-network medical services, for example, could be a deciding factor for you. Concerns over which health plan will save you time on paperwork and filing claims should be takin into consideration. Which health insurance plan is best for senior citizens with pre-existing conditions versus a 28 year old with great health can also change. Upfront costs or premium fees certainly vary from program to program, so understanding what features are included at what price points can help you clarify what plan aspects you should prioritize over others when choosing the right plan for you. By the end of reading this section, you should have a much clearer idea of how health insurance plans work and which may best suit your individual needs.