Medical Insurance

Choosing the right medical insurance can be a difficult and confusing endeavor. The primer below is designed to give you a basic overview of what to look for in an insurance plan.

How to Obtain Medical Insurance

If you are fortunate enough to get health coverage through your job, your premium payments are most likely deducted from your check. Many companies offer basic coverage including emergency room costs, doctor’s visits, prescriptions, x-rays, lab tests and chiropractic care. Additional health insurance is often available to cover dental, vision and long-term conditions. This type of supplemental insurance will most likely involve additional fees.

If you freelance or are a small business owner, you may need to purchase an individual medical insurance policy. This can be accomplished by contacting an insurance carrier or by contacting an insurance broker. The benefit of using an insurance broker is that a broker is not tied to any one carrier and can provide you with a variety of different rates.

However, a note of caution about choosing an individual medical plan — be sure to check the rating of your company with A.M Best, which evaluates the fiscal health of various insuring agencies. If the carrier’s rating is less than A, you need to keep searching for other options.

Types of Health Insurance

There are two main types of medical coverage; fee for service plans and managed care. Under fee for service plans, you will need to submit a claim for each medical cost. You are then reimbursed for each covered expense.

Under managed care, certain rules and regulations apply to keep healthcare costs as low as possible. Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) are two types of managed care plans. With PPOs, you have the option to see any doctor within the PPO network. You may also be referred by a PPO doctor to another doctor outside the network and still receive the lower cost. However, if you decide to see a PPO doctor outside of the network without a referral, your bill may be significantly higher.

HMOs stipulate that you must visit a doctor within the HMO network with the exception of emergencies. HMOs are excellent for covering routine medical costs such as checkups, flu shots and hearing tests. However, although HMOs are considerably easier on the pocketbook, they offer much less flexibility than PPOs.

Policy Checklist

Whether comparing programs offered through your job or shopping for medical insurance on your own, you should take the following into consideration:

• Your overall health and the health of your family.
• Does anyone in your family smoke?
• How the medical insurance plan handles fundamental care.
• Out-of-pocket costs to you.

When investigating an insurance carrier, you may want to ask yourself the following questions:

• How often will you need to see a doctor? Do you or any family members require specialized care?
• Will the plan cover the basics beyond annual office visits? How does the medical plan handle maternity care, prescriptions, surgery, hospitalization, lab costs and other medical fees?
• Is there a deductible, or amount of money, that you need to pay before the medical insurance plan begins to extend coverage? What is the co-pay, if any? (A co-pay is the difference between what the carrier covers and what you pay out.)
• How much will it cost to see a doctor outside of your plan?

All of these factors need to be carefully considered before choosing a health insurance plan.

Supplemental Medical Insurance

Beyond basic medical coverage, you may wish to investigate supplemental coverage such as vision care, dental care, disability insurance and long-term care insurance. For instance, many plans cover dental cleanings and eye exams but do not cover more extensive procedures. Disability insurance pays out an income if you are unable to work and long term care insurance can cover costs associated with an extended illness, such as at home care and physical therapy.

Take care to fully investigate the terms of any supplemental insurance that you choose to purchase.

[tag]insurance,med[/tag]