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Health Insurance Basics

Health insurance is a necessity for allyour  premiums.
individuals. This is because even a minor
illness can quickly become a life threateningManaged care plans use "networks." This means
condition that you can cost thousands ofthat you have to choose from a specific list
dollars to treat. Many illnesses have beenof doctors, clinics, hospitals and health
financially devastating to many people andcare providers. These providers are
families and having adequate health care cancontracted with your plan to provide services
assist you in covering those medical expensesto members of the plan. Some managed care
as well as helps to ensure that you canplans will require that use only providers in
afford  preventative  medicine  as  well.the plan for your routine care. Others will
pay for care from any provider, but offer you
It is important to understand how healthmore financial incentives for sticking with
insurance coverage works before you purchasethose  in  the  network.
a plan. The health insurance plan that you
choose must meet your needs as an individualManaged care plans are usually a more
or family. There are several different typesaffordable option. Managed care networks
of health coverage available and having anprovide healthcare professionals with
understanding of health plans can help you"built-in" clientele, thus allowing them to
choose  the  right  one.lower their rates. These plans also emphasize
preventative care to keep medical conditions
Health care plans will typically pay forat bay. In general, the trade-off for these
most, and possibly all, of the cost ofprograms is that you may not be able to use
treatment for illnesses and injuries. Theseyour doctor of choice, but you will receive
are usually classified as "managed care" orincreased  affordability.
"fee  for  service."
There are three types of managed care plans
Most people are familiar with "fee forincluding:
service" plans and they are often referred to
as "indemnity plans." These are plans thatÂ- Preferred Provider Organization Plans -
are sold by traditional insurance companiesThese allow you to go to any provider you
and you can go to any doctor you want and youwish, but you will save if you use providers
don't require a referral if you need athat are in the network. You do not have to
specialist. A fee-for-service plan will oftenselect a primary care physician for a PPO
pay for most of the costs of treatment forplan.
medical conditions that are covered in the
policy. In most cases, your healthcareÂ- Health Maintenance Organizations - These
provider will bill the insurance companyrequire you to only receive care from
directly for the cost of your care, but inproviders within the network. There are
some instances you may have to pay the billexceptions should a medical emergency occur.
and then file a claim for reimbursement withWith a HMO, you will have to choose from a
the insurance company. With a fee-for-service"primary care physician" list. Your physician
plan, you will be required to pay a premium,will oversee your medical care and provide
deductible  and  coinsurance.you with referrals to specialists and other
providers  you  may  need.
Co-insurance is the portion you have to pay
once you have met your deductible and theÂ- HMOs with a POS (Point-of-Service) - If
plan begins to pay benefits. Generally, yourthis will allow you to use a healthcare
plan will pay 80% after the deductible hasprovider outside of the network, without
been met, but you are then required to payfirst having to receive a referral. However,
the leftover 20%. The amount that theyou will pay more for using those providers.
insurance company pays depends widely on theA POS plan may also exclude the option for
state you live in. As with a deductible, theout-of-network care in certain medical
higher you pay in co-insurance, the lowersituations.



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