Individual Health Insurance Plans

Remy Vixamar asked:

In a country like the United States, if you do not want to be buried in debt; you need a good health insurance for yourself and your family. Whether you are an employee or self-employed, it is necessary that you have a good health insurance coverage to cover your medical bills. However, there is no unique health insurance plan good for every one; benefits and costs vary from an individual to another (due to age, medical condition, etc.). To make a good choice, you need to know what benefits you are looking for, and examine each plan to find the one that best responses to your needs.

Although you have many options in choosing your health insurance, finding the right plan can be difficult. In general, individual health insurance is a form of contract between you and an insurer (insurance company )to repay all or almost all of your medical bills, which may includes hospitalization, medications, dental care, seeing a specialist, and certain therapies (radiotherapy, chemotherapy, etc.).  Whatever your needs, you will most likely have to choose one of these plans, Fee-for-service, HMOs (Health Maintenance Organizations), or (PPOs) participating provider organization.

Fee-for-service – also known as indemnity plans, is a type of insurance plan where you, patient, have to pay all medical expenses out of your own pockets, and then request a reimbursement from your insurance company. These types of plans have their advantages and disadvantages.

Advantages: they offer more flexibility in choosing your own doctor. You can decide the time to see your health care provider, and what type of treatment you want; as long as you remain in the limit that your insurer will repay

Disadvantages: in indemnity plans, most doctors require upfront payment, so you have to submit claim forms to the insurance company to receive a reimbursement. That requires paper work, and sometimes many phone calls. Fee-for-service plans offer limited benefits; they do not cover annual physical exam and educational programs.

HMOs (Health Maintenance Organizations) – Health maintenance organizations (HMOs) are managed care plans that offer health care coverage to their members through hospitals, doctors, and other health care providers that are in their network. That is, having their service, you are limited to members of their network.

Advantages: unlike Fee-for-service plans, you do not have to pay up front; although some of them require a copayment. You do not need to submit forms after forms to receive reimbursement. In addition, HMOs usually charge a lower cost.

Disadvantages: you can use only health care providers who are associated with the organization. Most HMOs (Health Maintenance Organizations) tend to disapprove certain treatments. Although some HMOs accept their members to see physician or specialists who are not in their network, they often charge you additional costs.

(PPOs) participating provider organization – also known as Preferred Provider Organizations,  is a form of managed care organization of physicians , hospitals, clinics and other health care providers that sign a contract with an insurer to provide health services to its member at reduced rates .  Usually, PPOs cost more than traditional HMOs, but offer more options to their members.

Advantages: Preferred Provider Organizations provide more flexibility to their members; they have a bigger network of doctors and hospitals. You can take service from health care providers that are not part of their networks (certain charges often apply). You pay Lower copayments for care from primary care physicians. In addition, you do not need a referral to see a specialist.

Disadvantages: PPOs cost more than traditional HMOs. You will more likely to make co-payments (usually from $10 to $30) when you visit a health specialist.

Do some health insurance companies offer better service to their members than others?

Yes. Some insurers offer better service to their members. To learn more about health insurance companies that provide satisfying individual health insurance plan in the US, visit our top rated list visit, or click on the link in About Author/Resource box.

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