The least expensive option for obtaining private health insurance is through an employer-sponsored plan. If you work for a business that offers health insurance, either as mandated by the Affordable Care Act (ACA, or Obamacare) or if they choose to provide coverage as an added employee benefit. While it is up to the employer to determine what time of plans are offered, be it a single option or the ability to choose from multiple types of insurance plans, your employer will pay a portion of your policy costs.
If you do not have access to employer-sponsored health insurance coverage, then you may find policies either on your state’s health insurance marketplace (established through Obamacare) or directly from insurance providers. As you research your options, you will want to understand what coverage is available and what you can expect is included in your plan.
Some insurance policies have a network of providers they work with to help drive the medical costs down. These are considered managed care. There are various types available, including:
- HMOs: Health maintenance organizations normally pay for medical care received from providers within their network. These are typically more cost-effective compared to other plans that have wider networks.
- PPOs: Preferred provider organizations help to pay for more of your medical expenses when you obtain care from their network of providers. They also pay some of the costs for medical care obtained outside of their network of providers.
- Point of service: Each time you receive medical care you can choose between an HMO or PPO. This allows you the flexibility in selecting the physicians and medical centers you want to receive care from.
Aside from managed care plans, there are what’s known as indemnity plans or fee-for-service options. These are different from the others, since you aren’t restricted in your choice of hospitals and doctors. The doctors you see are paid a fee every time your plan covers medical care you obtain. Do note, however, that these plans have higher out of pocket costs.
Aside from the minimum essential benefits as defined by the ACA, each insurance policy will offer different coverage options at different rates. Now, let’s go into the different types of coverage included in private health insurance policies.
Health insurers want their policy holders to stay healthy (and not need expensive, long term medical attention), and providing preventative care is one way to ensure that. Preventive care consists of visits to the doctor and other medical professionals who check your health regularly. These wellness visits are essential for identifying and treating any problems early on and potentially nipping them in the bud.
Unfortunately, not all medical problems are caught or arise during preventative care visits, so private health insurance also covers emergency care. This is a must-have for individuals and families alike. Disaster can strike at any moment in the form of a car accident, work-related accident or unexpected illness. Some plans even offer coverage for emergency outpatient minor surgeries. Others take it a step further, allowing policy holders to obtain diagnostic x-rays and lab services from outpatient providers.
You’ll find some plans requiring a waiting period of 9 or 10 months before maternity care is covered. It’s important to read the fine print because some plans won’t cover all the expenses for maternity, delivery and post-delivery care. Check to see what the maximum dollar amount is, if so, and what the maximum number of days are for your hospital stay if you have plans to become pregnant and are shopping for health insurance.
General Treatment Coverage
Plans from private insurers normally cover some or all of the treatment provided by ancillary health service professionals. This includes dental care, podiatry, occupational therapy, contact lenses, glasses, prostheses, nursing home and chiropractic care.
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