Four Basic Types of Health Insurance
54From the moment we're born, our health is of the utmost concern. Consequently, the healthcare industry is the largest industry in the country, and there are countless organizations that sell everything from diet plans and pills to exercise equipment, all in the name of good health. But ensuring that you and your family are healthy often costs a lot of money. Doctor visits, emergency care, prescription medicine, and dental care are just some health treatments that come with heavy price tags. The high cost of health care is why many companies offer yet another service to help promote good health by helping pay for medical expenses--health insurance.
The concept of health insurance is not new. Health insurance was first proposed as early as the seventeenth century, and by the late nineteenth century insurance that would pay for medical expenses caused by accidents began to be available. The Franklin Health Assurance Company in Massachusetts was the first United States organization to offer accident insurance. This accident insurance was meant specifically for workers who worked in dangerous jobs such as those in the railroad and steamboat industries. The concept of health insurance began to grow from then, until 1890 when health insurance not only included accident coverage, but coverage for sickness as well. And the first employer-sponsored group disability policy was offered in 1911.
Today, health insurance is a benefit that is offered by many employers to their employees, and most private programs go beyond covering medical expenses caused by accidents and sickness and also provide coverage for routine, preventative, and emergency health care procedures. And whether you're looking for Raleigh health insurance or health insurance in Greensboro, the state of North Carolina houses several quality insurance providers to meet your needs.
Of course, many people are on their own when it comes to purchasing their insurance policy, and there are quite a variety of health insurance types to choose from that vary in the size of their premiums, deductibles, and coverage. The following are descriptions of the four basic types of health insurance so that you can better understand what type of plan would be right for you.
Fee-for-Service
Fee-for-service health insurance is a type of traditional insurance that provides the greatest autonomy to its clients. You have complete freedom when it comes to choosing doctors, hospitals, and other healthcare providers. If you want to a see a specialist, you don't have to have your doctor refer you to one. You can see whomever you choose in the healthcare industry, and the insurance company does not decide if it is necessary or not. While fee-for-service programs are somewhat managed, they give people the greatest amount of control in deciding what kind of care they want.
The drawbacks to fee-for-service plans are mainly financial. The deductible is usually much higher than other health insurance plans and can range from $200 to $2,500. After you have paid the deductible, insurance will usually pay for about 80 percent of any other medical bills. With fee-for-service plans there is usually a ceiling at which the insurance company will pay 100 percent of you medical costs, but that ceiling is usually quite high. And you may have to pay the bill upfront and later submit a bill for reimbursement to your insurance provider, although some providers may pay the medical expenses directly.
The other drawback to fee-for-service plans is the "reasonable and customary" rule. Insurance providers will only cover medical expenses that are deemed both reasonable and customary, which means many types of check-ups such as pelvic exams are not usually covered by fee-for-service insurance plans; however, this is not true for every fee-for-service insurance provider.
Fee-for-service plans are perfect for those who want control over what doctors and specialists they see. This flexibility and autonomy, however, comes with a price, as fee-for-service plans usually have higher deductibles and out-of-pocket expenses.
Preferred Provider Organizations
Preferred Provider Organizations, more commonly known as PPOs are a type of managed health insurance that provides lower fees than fee-for-service programs. With PPOs, insurance companies work with a network of healthcare providers in the community and give policyholders a financial incentive to use the medical services within that network.
Basically, if you go to a healthcare provider within the PPO network, you will have to pay a small co-pay amount. But if you visit an out-of-network healthcare provider, you will have to pay the entire bill out of your pocket and then submit a bill for 80 percent reimbursement, and you may also have to pay a higher deductible than if you were to stay inside the network.
Similar to fee-for-service plans, you can refer yourself to any specialist without a doctor, but that specialist has to be within the PPO network in order for you to enjoy the low co-pay. And preventive care may not be covered under a PPO
PPOs are good health insurance plans for people who want a cheaper health insurance, but also want the flexibility and autonomy to go to other out-of-network doctors if they so choose. PPOs are a good balance between the expensive, flexible fee-for-service plans and the cheap, but more restrictive HMO plans.
Point-of-Service Plans
Health Maintenance Organizations
Health Maintenance Organizations, also called HMOS, are the cheapest, but also the most restrict, type of health plan. Within an HMO, you are required to only see doctors and other healthcare providers within your network, and you have to be referred by your primary care physician in order to see a specialist. If you do not visit an HMO-approved physician, you will have to pay the entire cost yourself. On the plus side, HMOs do usually cover preventative care and health improvement services and programs.
HMOs are usually offered to groups and are most beneficial to those who are willing to sacrifice flexibility for a low cost.
If you're looking for health insurance in Charlotte and the surround area, there are several quality providers to choose from. By knowing more about the different types of health insurance, you can better decide what type of plan is best for you and your family.
- Charlotte Health Insurance
As an independent insurance agent, Absolute Insurance can provide North Carolina residents with all types of Raleigh health insurance and Greensboro health insurance coverage from the top carriers in the country.
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