All You Need To Know About Health Insurance Coverages

May 09, 2020

Health or medical insurance is a type of insurance that covers your surgical, medical, and in some cases, dental expenses. If you have health insurance, it either reimburses you for the costs incurred or pay directly to the hospital. You can buy one anytime. However, many employers offer health insurance coverage as a part of employee’s benefits to entice quality employees.

With the employee’s health insurance, the employer partially covers the premiums but often deducts it from the employee’s paycheck. The benefits received against health insurance are tax-free.

Health insurance: A Brief Guide

Health insurance is a complicated affair. Therefore, you must familiarize yourself with the basics of it. Whether you buy insurance from a broker or your state, you will have to choose a health plan according to the benefits they offer.

There are four plans to choose from, including bronze, silver, gold, and platinum. If you are under 30, you may be eligible to get a catastrophic plan with high deductibles. A deductible is an initial amount you pay every time you claim your health insurance

Each of these coverages is different, and there is no set standard. Therefore, the details of these plans may vary with health insurance providers. However, all these plans work on a basic principle where they cover a certain percentage of your bills, and you take care of the remaining percentage.

Types of Coverages

Bronze Coverage

The health insurer covers 60 percent of your medical bills, and you pay the rest.

Silver plan

 The health insurer covers 70 percent of your medical bills, and you pay the remaining 30 percent.

Gold plan

 The health insurer will pay 80 percent of your medical bills, and you will cover 20 percent.

Platinum plan

 Your health insurer covers 90 percent, and 10 percent comes out of your pocket.

Catastrophic plan

This plan covers you for both emergencies and preventive care. However, it has low premiums and high deductibles. The average deductible for these plans of plans was $ 7,148 as of Feb 2020.

Types of Plans

There is a multitude of health insurance providers available these days. Each of them offers one or more of the four types of plans.

Free-for-Service

It is also known as the “Traditional Indemnity Plan.” In this plan, you can simply book an appointment with your care provider without any prior permission from the insurer. You pay your bills, and the insurance company reimburses. However, you have to pay the high deductible from $200 to $2500 before the insurer steps in.

PPO

PPO stands for “Preferred Provider Organizations.” PPOs usually have a network of care providers and have lower fee agreements with them. You will have to stick with the doctors within their network, and it will cost you as low as $10 per visit. You can see a doctor from outside the network, but you will have to pay the bills out of pocket. You can then submit the bills to the insurer from 80 percent reimbursement.

POS

POS or Point-of-service work somewhat similar to PPO, but it employs a Primary Care Physician (PCP). To get a referral, you will see the PCP for an initial check-up, if the PCP refers you to a doctor. If the doctor is within their network, you are fully covered. In case if PCP refers you to a doctor outside the network, then most of the medical costs are covered. However, if you refer yourself to a doctor, then you will have to pay out of pocket and submit the bills to the insurer for reimbursement. You may also incur high deductibles in this scenario

HMO

Health Maintenance Organization is the least expensive and least flexible of all plans. It abides you to see their doctor only, and only this doctor can refer you to visit a specialist.

Choose wisely

There are a lot of health insurance providers out there. Therefore, do your research, read their terms and conditions, and confirm your coverage plan to know what you are getting to avoid any last-minute shocks or disappointments.