Health Choices

Health Insurance 101

Health insurance is not cheap and it can be tempting to go without health insurance. With the expensive monthly cost and out-of-pocket costs, you may be wondering if you really need health insurance. Many people in their twenties feel they are healthy enough to skip the health insurance. When you are healthy and rarely see a doctor, it may seem like a good idea to cut out health insurance completely and to justify going without it. You can pay for things as you go instead of worrying about the insurance premiums and co-payments on the way. However, this is faulty reasoning. It is essential for everyone to always have some form of health insurance.

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There are two main types of health insurance:

  • Private health insurance:

Private health insurance is an insurance policy which covers the cost of private healthcare. It works in a similar way to any other insurance – you pay monthly or annual premiums, and your provider pays out for some or all of the cost of the private medical treatment you receive.

You can take out a single policy for yourself, or a joint policy to cover you and your partner. This can make things easier as you’ll only have one provider, one policy, and one point of contact to deal with.

The Centers for Disease Control and Prevention (CDC) say that the U.S. healthcare system relies heavily on private health insurance. In the National Health Interview Survey, researchers found that 65.4 percent of people under the age of 65 years in the U.S. have a type of private health insurance coverage.

  • Public or government health insurance: In this type of insurance, the state subsidizes healthcare in exchange for a premium. Medicare, Medicaid, the Veteran’s Health Administration, and the Indian Health Service are examples of public health insurance in the U.S.

Type of insurance:

People also define an insurer by the way they administer their plans and connect with healthcare providers.

  • Managed care plans: In this type of plan, the insurer will have contracts with a network of healthcare providers to give lower-cost medical care to their policyholders. There will be penalties and additional costs added to out-of-network hospitals and clinics, but they will provide some treatment. 
  • Indemnity, or fee-for-service plans: A fee-for-service plan covers treatment equally among all healthcare providers, allowing the insured to choose their preferred place of treatment. The insurer will typically pay for at least 80 percent of costs on an indemnity plan, while the patient pays the remaining costs as a co-insurance.
  • Health maintenance organizations (HMOs): These are organizations that provide medical care directly to the insured. The policy will usually have a dedicated primary care physician that will coordinate all necessary care.

Do you know?

  • The more expensive the policy, the more flexible it is likely to be with the network of hospitals.
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