Health insurance provides invaluable protection should you become ill or have an accident. There are so many different types of policy available that it can be difficult to find the product most suited to your needs. To help you we have answered some of the most commonly asked questions that people ask when they start looking for a health insurance policy.
What is health insurance?
Health insurance covers the cost of your medical bills in accordance with the terms specified in your policy. You pay a set amount known as a premium to your insurance provider on a regular basis. The majority of Americans take out private health insurance, either by purchasing a policy themselves, or via their employer. If you are struggling to pay for health insurance you may be entitled to cover under programs such as Medicaid and Medicare.
Why do I need to take out health insurance?
Health care treatment in the US is incredibly expensive; a three day stay in hospital can cost around $30,000! If you don’t have health insurance this could lead to financial ruin, so it is important to take out a policy that will pay for all eventualities including simple checkups and more serious illnesses and/or accidents. The Affordable Care Act’s “individual mandate” actually stipulates that the majority of Americans take out health insurance that provides “minimum essential coverage.” Going without insurance could result in a tax penalty.
What should I do if I can’t afford to pay for health insurance?
If you are finding it difficult to pay for a health insurance policy then you may be entitled to subsidized cover via Obamacare’s state health insurance exchanges; this depends upon your income. Alternatively, you may qualify for low-cost or free coverage through schemes such as Medicaid or the Children’s Health Insurance Program.
What type of plans are on offer?
There are two main types of plan available; an indemnity health plan, and a managed care system. Also known as fee-for-service plans, an indemnity health plan means that you have to pay a certain percentage of your medical costs, and your insurance company pays the remaining amount. In most cases you are entitled to choose your own doctors. A managed care plan, on the other hand, results in you paying out far less from your own pocket, and includes a health maintenance organization plan (HMO) or a preferred provider organization (PPO) plan. If you have a HMO either you, or your employer, are responsible for paying monthly for your health care, however, you can only visit a doctor who is contracted by the HMO plan. With a PPO plan you can opt to visit a doctor who is not contracted by the PPO plan but you will have to pay an additional sum.
How much will I have to pay towards my medical bills?
Initially, you will have to pay for your premium (usually monthly), and you may also have to pay a small flat fee for healthcare services; often around $10. Some plans also feature a deductible, which is the amount that you have to pay yourself before the policy starts to cover any costs. Next, you may have to pay a certain percentage towards costs after the deductible has been met; check with your insurance provider before signing up as all plans vary.
Do I have to call my doctor prior to visiting the Emergency Room?
Yes, some plans do stipulate that you must contact your doctor within 24 hours of visiting the Emergency Room; be sure to check the small print.
Can I still continue to use my current doctors?
Some plans insist that you only use doctors who are contracted to the health insurance policy. Before signing up check that the doctors and hospitals covered include your current doctors if you wish to continue to use them.
What do health insurance plans include?
Some plans include vision care, dental care and prescriptions, plus other routine tests including immunisations, mammograms and dental treatment; check with your provider before taking out your policy to see what is covered.
What if I suffer from pre-existing medical conditions?
If you, or a member of your family, suffer from a chronic condition the policy may not cover the medical costs related to this condition for a number of months, and sometimes not at all. Ask your health insurance provider how long pre-existing conditions are excluded for?
How can I tell if a health insurance provider is reliable?
Do some investigations online and find out if the health insurance provider you have in mind has been established for a long time. Check also to see if they have received favourable reviews from their existing customers. All insurance providers should have procedures in place for negotiating denied claims; either in-house or via an arbitrator who is impartial and considers both sides very carefully. Ask how long it usually takes for the company to resolve disputed claims.
What happens if I fall ill or suffer an accident whilst travelling overseas?
Every plan is different so you need to check with your intended health insurance provider to establish how much, if any, of the costs incurred when visiting a hospital or doctor overseas are covered, and if they are, how are the funds reimbursed.