Health
Insurance for Dummys
Health Insurance for Dummys Health insurance is really not all that complicated. Most policies are very similar, with small differences in coverage. Let's talk about the basics.
All policies contain a major medical portion that is designed to cover hospital stays, outpatient surgeries, extensive testing, accidents, etc. In addition, the policies we quote for you have copays for doctor visits, and most have copays for prescriptions.
Now, what is a copay? This is separate from the major medical portion of the policy. In other words, the deductible does not apply to them, nor does the amount you pay for the copay apply toward the deductible. You do not have to meet your deductible before you get the copay benefits. As an example, if you visit your doctor, you pay them the copay ($25 or $30), and the insurance company pays the rest. The same is true for prescriptions. You pay the pharmacist the copay ($10 or $25), and the insurance company pays the rest. You're not even worried whether you've met your deductible or not at this point.
When does the deductible apply? Generally it applies to everything else except your trip to the doctor or a prescription. That may include lab work, x-rays, casts, wheel chairs, home health care, surgery, etc.
See how much you've learned so far! Now let's talk about the major medical part of the policy. Each person insured has a deductible to meet each calendar year. After your deductible, which is the part you would owe the doctor or hospital, your policy will now pay anywhere from 80 - 90% of the bills. You will pay 10 - 20% of the bills over the amount of your deductible. All policies have a provision that eventually they will pick up 100% of your bills, and you owe no more for the year.
Now that you've done so well, we'll go one more step. PPO policies. PPO stands for Preferred Provider Organization, which simply means that with certain insurance companies you have to be using their doctors and hospitals to get the most out of your policy. No, they don't tell you which doctor to use, you simply have a list of doctors in your area and you may use any of them. Today, most doctors are on the lists, so it's not often a problem to find a company in which your doctor is a provider. This list of doctors is what we call a "network." Many companies may use the same "network" and we'll give you details online about finding out if your doctor is in the "network".
There are differences in the major medical part of your policy as to what each company will cover or help pay for. Some companies don't cover any expenses related to maternity, or mental and nervous conditions. Several companies limit how much they will pay for different expenses such as ambulance or hospice care. Particulars of these limits are provided to you online or in the company brochures that are also available online. This way you can study the differences and also compare the prices.
Now we’ll go a different direction. The Health Savings Account. This is a two step process. First you apply for an insurance policy with a high deductible and no copays for doctors or prescriptions. Usually the premium for such a policy is very low compared to other “traditional” policies. The theory is that you would save the difference in a special account to be used to pay for medical expenses NOT covered by the insurance policy. It’s called a Health Savings Account or HSA. Every dollar set aside is totally tax deductible.
See how easy it is to shop for insurance? We also have people on our staff to help you. We'll answer questions you have about the policy you're considering, or the insurance company, or even just our help, or advice or "inside information." We know these companies and are glad to help you sort through this maze of policies. After all, we want to make you a client, regardless of which company you choose, and hope that our effort will earn us that relationship.
You might look at our "Questions" page for additional information. By the way, more than 30% of our "new clients" are referred to us by other clients. We must be doing something right. Give us a try!
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