Health insurance coverage is what provides help in paying the costs a policyholder’s medical expenses that may arise, even surgical operations. The insured is compensated for any medical costs or the insurance company pays the doctor, hospital, clinic, laboratory, pharmacy, or health practitioner directly.
Regardless of one’s age or health, everyone needs to have health care that varies from an annual physical check-up to specialized procedures. During a challenging health crisis, it is best that the patient be able to focus on recovering rather than being concerned with paying sky-high medical bills and individuals with insurance in place tend to catch life-threatening illnesses early on, which can lead to the proper treatment in often the nick of time.
Health care is designed for individuals of all ages and types and it is now mandated as per the Affordable Care Act. Besides the mandate, this kind of insurance allows one to visit a myriad of practitioners who specialize in anything from pediatric care to senior citizens needing geriatric care. Note that often if one needs to see a specialist, insurance companies will usually insist that the insured individual obtain a referral from their primary care physician.
There are basically two kinds of health insurance categories. The first is private in which privately held companies, employers, and other organizations offer insurance. The second category is public where all the coverage is issued by the government. Some countries have a mixture of both private and public insurance offerings, while some have in place a single-payer, government-run system.
There are four main kinds of plans generally available and they are:
• Managed Care Plans
Managed care plans generally have lower rates with medical facilities and healthcare providers who make up a plan network. The insured individual normally needs to exclusively receive care from within the provider network.
• Indemnity Plans
These types of plans are in place to pay for at least 80% of medical services that are covered, minus any deductible, and allow one to choose any provider he or she prefers. There is almost always an out-of-pocket maximum for which the insured is responsible within a 12-month period of time.
• Health Maintenance Organizations (HMOs)
These organizations were created to care for the insured directly in their own facilities. The insured pays a set monthly amount for a premium and will receive a range of services in exchange. HMOs require care to be given from within its network of facilities.
• Preferred Provider Organizations (PPOs)
These plans are quite similar to indemnity plans as the insured person is at liberty to see any healthcare provider they choose. The difference is that outside-of-network providers are more costly.