Health insurance is as important as similar protections for your home, car, or life. It helps get you through basic and critical conditions without extra worries about how you’ll pay the bills. Yet, nearly 32 million adults, approximately 10% of the U.S. population, don’t own a policy. Needless to say, it’s time to purchase it through your company or government. To help out here’s some information to understand about your medical plan.

How Health Insurance Works

Medical plans pay designated costs for the policyholder. In return, the insured makes regular payments to keep the policy active.

Most policies also ask their customers to pay a deductible. The value is a payment you make before the plan covers 100% of health care costs. These vary according to individual plans. The least expensive a policy is the higher the deductibles. Here are some examples.

• Platinum Plans cover 90% of medical costs while you pay 10%.
• Gold Plans cover 80% of medical costs while you pay 20%.
• Silver Plans cover 70% of medical costs while you pay 30%.
• Bronze Plans, which are the most common, cover 60% of your medical costs while you pay 40%.
• Catastrophic Plans pay after the high deductible is reached. The value can be as much as $8,000. Even if you haven’t met your deductible, a catastrophic plan must cover the first three primary care visits and offer preventive care for free.

Medical Plan Types

There are several medical plans available on the market. Each varies depending on the insurer.

Health Maintenance Organization (HMO)

An HMO is the most common insurance plan offered by companies and government marketplaces. It permits policyholders to utilize general practitioners (GPs) and hospitals within a company’s network. Referrals are needed for patients to see specialists. Medical professionals outside the HMO’s network won’t be covered except for emergencies.

Preferred Provider Organization (PPO)

The PPO is a step above an HMO. You have more freedom to choose your health care providers. Plus, a referral isn’t required to see a specialist. You can see out-of-pocket physicians; however, you will pay more for their services. In some situations, you pay a low flat fee before an appointment.

Exclusive Provider Organization (EPO)

An EPO is a combination of an HMO and PPO. Deductibles and premiums tend to be lower, and referrals aren’t needed to see an in-network specialist. Like an HMO, the EOP doesn’t cover out-of-network practices and hospitals except in emergencies.

Point-of-Service (POS)

The POS plan is another lower-cost option than a PPO. You have more choices than in an HMO. Like a PPO, you can select someone out-of-network but will pay more for their services. While you don’t require a referral, the GP must set up appointments with specialists if they deem it necessary.

Medicaid

Medicaid is a federally sponsored medical plan that helps defer costs for children, families, and others who qualify. Customers can visit GPs, hospitals, and specialists certified by individual states. Normally, Medicaid offers no premiums and low deductibles. Annual check-ups and preventive care are usually free.

Medicare

Medicare is the federally sponsored plan for adults who are 65 or older. Those who collect social security obtain automatic registration for Part A & B coverage. Thus, they receive coverage for hospitalizations and GPs.

However, Medicare is more than those packages. Medicare supplement plans in Nebraska have coverage to handle items like specialists and pharmaceuticals. The plan requires the most paperwork out of all the ones listed. It’s best to work with specialists at companies like Omaha Insurance Solutions to complete and properly submit the necessary materials.

 

Health Care Spending Account (HCSA)

An HCSA isn’t a medical plan. Rather, it handles costs not covered by your insurer. You can create an HCSA account at your bank and have a portion of your other accounts automatically added. Or it’s a pre-tax deduction from your paycheck.

There are many medical plans to consider, and it’s not a good idea to pick one without the necessary research. Ask your HR department or marketplace for a comparison sheet with all the options. Ask pertinent questions, and don’t make a selection without getting the answers you need. In the end, your health and that of your family depend on it. 

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