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Why You Need Health Insurance: Other types of Health Insurance - HealthCompare


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Are you lost in the maze of confusion information about the price and cost of health insurance and health insurance plans? The experts at HealthCompare put together some slide to help you through the health insurance clutter and make finding the right affordable health insurance easy. provides Affordable Health Insurance Quotes and makes it easy to buy Individual Health Insurance, Family Health Insurance and other Health Insurance Plans.

Why You Need Health Insurance: Other types of Health Insurance - HealthCompare

  1. 1. Why You Need Health Insurance Health Insurance 101 Prepared by REV Media Marketing LLC March 2010
  2. 2. Who qualifies for Group Insurance? Most Americans either receive health insurance coverage through their employers or are covered by a family member’s policy. If you leave your job you will lose your employer-supported group coverage. COBRA (Consolidated Omnibus Budget Reconciliation Act) allows for an extension of coverage through the group health plan for a specified length of time, although the premium is usually higher. Not every employer offers health insurance, especially small businesses. You may not be eligible for health insurance if you work part-time.
  3. 3. How to choose a Managed Care Plan or Indemnity Plan? Indemnity health care plans offer a greater choice of care providers. You are not restricted to a specific group of physicians, hospitals, specialists or other health care provider. Managed care plans work within a network of doctors and hospitals or “providers.” To receive the benefits of the discounts negotiated with specific doctors, hospitals and health care providers, you must use services from providers in the health plan’s network. You’ll find some indemnity plans that offer managed care-type options, and some managed care plans that allow for members to use providers who are "outside" the plan’s specific network
  4. 4. How Do Managed Care Plans Control Costs? Three common types of managed health care plans •PPOs plans •HMOs plans •POS plans Health plans negotiate discount agreements with doctors, hospitals and other providers, and pass along the negotiated or discounted prices to plan members. HMOs use restrictions to control costs. You may need to select a primary care physician from a register of area physicians. Use as a gateway for all your health care needs and decisions, including referrals to obtain specialized medical treatment so costs can be managed easily.
  5. 5. What are HMOs? Health Maintenance Organizations (HMOs) often require you to see a provider within the network and to obtain referrals from a primary care physician. Questions to compare plans: •How do I determine which doctors are accepting new patients? •Can I change doctors? •How are referrals handled if I need care from a specialist? •How is emergency care handled? •What services are covered, including preventive care? •What if I need services not provided by the HMO network? •Are there additional fees or co-payments required for office visits, emergency care or other services and, if so, how much are they?
  6. 6. What are PPOs? Preferred Provider Organizations (PPO) are a form of managed care plan. •PPO does not necessarily require that you choose a primary care physician to supervise and make decisions for your health care. •In addition, with a PPO, you may be able to access providers and services outside of the “preferred” provider network. It is important to note that PPO plans will likely involve more out of pocket costs than an HMO. •PPOs typically involve deductibles, co-payments, and coinsurance amounts. •The increased financial responsibility with a PPO is a trade-off for the higher level or flexibility that you have in choosing a provider and accessing care.
  7. 7. Is a PPO right for you? Selecting your Doctors: •How many are in the network? •Who are they and where are they located? •What are the processes and restrictions for referral to specialists? Review hospitals: •What hospitals are available through the plan? •Where is the nearest one in the network? •How is emergency care handled? What services are covered? What are the deductible, co-pay and coinsurance amounts? What is the out of pocket maximum? What are the coinsurance amounts for non-preferred or out of network providers? Are there per-visit fees or other types of co-pays for in-network services? What is the cost difference between using in-network and out-of-network doctors, and what costs are associated with care outside of the PPO?
  8. 8. What is short-term health insurance? Short-term major medical insurance is temporary health insurance that offers gap coverage to guard against high costs of emergency medical bills. Short-term major medical insurance is appropriate for: •Recent graduates who are between parental and employer coverage. •Employees who are on extended leaves of absence. •Employees who have been laid off or former employees between jobs. •New employees who are not yet eligible for the employer’s group coverage. •Early retirees. •People who leave a group policy and want an alternative to COBRA
  9. 9. Do you have to pay upfront for your deductible? High deductible health plans (HDHP) are policies that require a higher deductible than most health plans, typically at least $1,000 for single insurance coverage and $2,000 for family coverage. High deductible plans generally have lower monthly premiums than more comprehensive health plans. When comparing HDHP costs with the costs of other plans, consider the potential premium costs relative to your potential health spending for the coming year to determine which plan works best for you and your family
  10. 10. Sponsored by HealthCompare We Guide. You Decide.