Are You Dreaming of Free Medical Care? Wake up!

September 20, 2023

For now, all we can do is to learn how to get the health insurance policy to cover our needs without spending in excess or paying for coverage you’ll never use.

Obviously, you hope you and your family won’t have to use your health insurance policy, but in today’s society, the chances are great that you’ll need the coverage of a health insurance policy more than once during the course of a year. Without at least a minimum amount of coverage, just a visit to a general physician and lab fees can be astronomical. It’s important to get and maintain an adequate health insurance policy both in terms of health and financial security.

To get a health insurance policy that’s not outrageously priced, yet still covers your anticipated and unexpected healthcare costs there are three steps you need to take. 1) Careful evaluation of you and your family’s health insurance needs. 2) Compare health insurance policy benefits with your needs. Try to review at least three levels of coverage. 3) Your result will be a health insurance policy that’s not outrageously priced; yet still covers your anticipated and unexpected healthcare costs.

Determine Your Needs Whether you’re looking for an individual health insurance policy, or want to provide health insurance benefits for your employees, it’s a good idea to carefully evaluate your needs before committing to any health insurance policy.

For the individual, consider your overall health. Do you have chronic conditions that require regular medical visits? Are you on prescription medications on a continuous basis? Either of these situations will make you want to compare co-pays and drug coverage carefully.

Depending on your age, and stage of family planning, pregnancy coverage, and preventative care could be a major concern. If you’re nearing retirement age, getting supplemental coverage for impending Medicare benefits could be a major concern.

Everyone has his own special concerns and needs. Before you visit an insurance agent, be sure to list your concerns and questions. Don’t hesitate to ask questions until you’re confident you have enough information to make a confident decision as to which health insurance policy you need.

Understanding Health Insurance Coverage-Basic Health Insurance Policy Terms As you begin to compare each health insurance policy and the level of coverage provided make sure you understand clearly what the policy covers and what’s not covered. You’ll also want to know levels of coverage. Listed below are a few commonly used terms to describe health insurance policy benefits. As you read these terms, understand this is a very generalized definitions, specifics of each term may vary from policy to policy.

Co-Payment – Often stated as “co-pay”, co-payment is the amount you must pay for each service. In managed care plans, you do not need to know the full fee charged by a provider, as you will pay the same “co-pay” regardless of the fee. Co-Insurance – a policy provision, by which the insured person and the insurer share the covered losses under a policy in a specified ratio, i.e., 20 percent by the insured, and 80 percent by the insurer. Comprehensive Major Medical Insurance – A policy designed to give the protection offered by both a basic and a major medical health insurance policy. Normally have a low deductible amount, a coinsurance feature, and high maximum benefits. Deductible- the amount you as the policyholder must pay before benefits begins to cover costs. Generally the higher the deductible, the lower the monthly premium will be.

Endorsement- sometimes called a rider, an endorsement is written to change the terms of a health insurance policy. This can occur with pre-existing conditions (see definition below)Major Medical Insurance -Health insurance to finance the expense of major illness and injury. Characterized by large benefit maximums ranging up to $250,000 or no limit, the insurance, above an initial deductible, reimburses the major part of all charges for hospital, doctor, private nurses, medical appliances, prescribed out-of-hospital treatment, drugs, and medicines. The insured person as coinsurer pays the remainderOut-of-Pocket Cost – The out of pocket cost is the total of all costs you must pay for service. This includes the annual deductible, the co-pay amount, and any fees in excess of the approved maximum charges for a service.

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