Health Insurance

If you've ever been sick or injured, you know how important it is to have Health insurance.

Health insurance plans range from policies that cover the costs of doctors and hospitals (fee-for-service or managed care plans) to those that meet a specific need, such as paying for catastrophic care.

These guidelines can help you choose the plan that's best for you. Don't forget to get a health insurance quote from us.

FEE-FOR-SERVICE HEALTH INSURANCE PLANS

These plans pay health-care providers a percentage of each service rendered, with the provider submitting a claim to your insurance company to reimburse the “covered medical expenses” under the policy.

With fee-for-service plans:
  • The portion of covered medical expenses you pay is called “co-insurance,” usually 20% of “reasonable and customary charges” (the prevailing cost of a service in your area). If a provider charges more than this, you'll have to pay the difference.
  • With most policies, once your expenses reach a certain amount, the insurer will pay the full reasonable and customary fee for covered benefits.
  • Deductibles are the annual amount of the covered expenses you must pay before the insurer starts to reimburse you. Generally, the higher the deductible, the lower the premium.
  • There might also be lifetime limits on policy benefits. Most experts recommend a limit of at least $1 million.

MANAGED CARE

naged care health insurance quotes and plans cover health services if received from selected providers and offer financial incentives for patients to use these providers. Instead of paying for each service you receive, coverage is paid in advance (“prepaid care”).

The three major types of managed health care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.

In an HMO, you'll pay a fixed premium for you health insurance, as well as co-payments for certain services — for example, $10 for an office visit or prescription. Your out-of-pocket medical expenses might be low, as long as you use providers in the HMO network.

As a rule, you must receive your covered medical services through the plan. Generally, you'll choose a primary care physician who coordinates your care, referring you to specialists when needed.

PPOs and POS plans combine features of fee-for-service insurance and HMOs. POS plans usually have primary care physicians, while PPOs don't. Both types offer more flexibility than HMOs, but premiums will probably be higher. With a PPO or a POS, you'll get some reimbursement for covered services from providers who aren't in the plan, although it will cost you more than choosing a network provider.

WHAT ISN'T COVERED BY YOUR HEALTH INSURANCE?

Although HMO benefits are generally more comprehensive than those of fee-for-service plans, no health plan will cover every expense.

Very few plans cover experimental procedures, eyeglasses and hearing aids, or elective cosmetic surgery. Some fee-for-service plans don't pay for checkups; and some plans don't cover normal pregnancy or childbirth. Health insurance policies often won't cover preexisting conditions, although federal law limits these exclusions.

Because no single policy covers everything, you might consider such single-purpose policies as:
  • Hospital-Surgical Policies (“basic health insurance”) provide benefits for a covered condition that requires hospitalization.
  • Catastrophic coverage pays hospital and medical expenses above a deductible.
  • Hospital Indemnity insurance pays cash for each day you're hospitalized, generally up to a designated period.
  • Medicare Supplement insurance (Medigap) helps cover some of the gaps in Medicare coverage.
  • Disability insurance provides income if illness or injury keeps you from working for an extended period.
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Top Ten Doctor Puns

10. Doctors take pains to prescribe relief.

9. A pediatrician is a doctor of little patients.

8. A doctor drank while putting on patients' casts. He was soon plastered.

7. Two podiatrists became arch rivals.

6. I couldn't decide which of two physicians to see. It was a paradox.

5. The cheap eye surgeon was always cutting corneas.

4. I didn't want to give the brain surgeon a piece of my mind.

3. Old doctors never die, they just lose their patience.

2. The old doctor’s practice of bloodletting was all in vein.

1. There was an eye doctor who wanted to re-locate but couldn't find a job because he didn't have enough contacts.

Resources

National Institutes of Health
National Heart, Lung, and Blood Institute
Centers for Disease Control and Prevention

FAQ

Q: How call I tell the difference between allergies and asthma?
A:
Allergies and asthma can easily be confused. They share some symptoms: wheezing, coughing, lack of energy. Allergies are part of a body's normal response system to a perceived harmful substance; asthma blocks of airways, making normal breathing difficult.

Allergies can be linked to such triggers as pollens, animals and foods; asthma is the result of extreme physical exertion. Allergies can be treated through pills, shots and lifestyle changes. Treatment will vary according to each individual case. Severity, frequency and regularity will be considered when prescribing treatment. Asthma is treated with inhalants to widen the passages to the lungs. Children with asthma may be especially susceptible to high concentrations of air pollution and smog. Consult your doctor.

Q: What is the difference between a viral and bacterial infection and are antibiotics prescribed for both?
A:
The germs that cause infection fall into two generally categories: viruses and bacteria. Viruses cause colds, flu, most coughs and sore throats; bacteria causes most ear infections, some sinus infections, strep throat and urinary tract infections. Antibiotics can be used for treating only bacterial infections and should not be taken for viruses.

Q: When is it appropriate to call 911?
A:
Anytime you feel you can't respond to a medical emergency yourself, or safely transport the patient to the emergency room, you should not hesitate to use the 911 emergency system. Here are a few situations when calling for help is advisable: Severe difficulty breathing, gasping for air or choking Convulsions or seizures of any kind Any severe injuries, including deep or extensive cuts If a permanent tooth has been knocked out. For any swimming accident where a child has been underwater more than a couple seconds For burns larger than fist For exposure to smoke or toxic fumes For head injuries For loss of consciousness You call also call the Poison Control Center if someone has ingested any harmful substance: (800) 282-3171.