Why Getting Medical Insurance Is a Must


If you’ve been paying attention to politics over the last few years, health insurance has been a hot topic. Many who didn’t have adequate medical insurance ended up paying the government in their annual taxes. Others, who had medical insurance found themselves paying sky-high prices for less coverage as the demand for insurance stiffly increased. This has left a lot of people to wonder if they should be getting medical insurance or if they should just pay out of pocket for their medical expenses.


Source: pixabay.com

What Is Medical Insurance?
Medical insurance is a type of policy that pays for your surgical, medication, and other related health expenses. When you’re injured or ill, your insurance company will pay the care providers for their services up to the specified amount in your policy. It’s important to note that there are tons of medical insurance providers. Each offers an array of various health insurance plans that you’ll need to assess so that you know what is and what isn’t covered in the policy.

As with any typical type of insurance policy, you’ll be expected to pay a monthly insurance premium. Also, you can expect to pay insurance deductibles and co-pays for your visits. Some health care plans will even place a maximum cap limit on the amount of money they will pay out for your plan on an annual basis. It’s important to understand all of these terms so that you can pick the right medical insurance policy for you.

Insurance Premium
An insurance premium for your medical policy is going to be the amount of money that you owe each month to your insurance provider. In some cases, you may be asked to pay your premium annually or semi-annually for simplicity purposes. It’s best to check with your insurance company to see which they most prefer.

Depending on the health insurance plan that you choose, you will likely be responsible for some deductibles. Many plans are requiring individuals to pay a set deductible amount before the insurance coverage will kick in. Other insurance providers may require necessary deductibles for more expensive procedures. For example, they may require the policyholder to pay $1,000 out of pocket before they’ll cover the rest of the medical procedure that was performed. Deductibles will change with the insurance provider and policy.

This simply defines the amount of money that you have to pay out of pocket when you go to a doctor’s visit. In most cases, this can be as little as $10 to $20. Your insurance provider will cover the remaining cost of the medical visit. For specialty doctors, you may be required to pay a higher copay as the visit is more expensive. It’s best to check with your policy to see what you’ll be expected to pay for your visits to varying doctors.

This term is commonly interchanged with the term co-pay, however, they mean different things. As you learned above, a co-pay is a set amount. Coinsurance, on the other hand, is a set percentage you must pay for the charges that the doctor has. This could be set at 20 percent of the cost of care or more depending on your policy description.

While each health insurance policy is going to have varying premiums, deductibles, and co-pays, there are some common things you can count on. Policies that offer a low monthly premium will likely have higher deductibles and co-pays. This can be ideal if you don’t have any major medical procedures performed as you’ll end up spending less money throughout the year on your medical insurance. However, if you have a major illness or accident, this could potentially result in large out of pocket expenses that will cost you more money in total for the year.

Various Types Of Medical Insurance
Now, you should have a fairly clear idea of what medical insurance is and why it’s a good idea to have it. There is not just one type of policy that is available to you. Rather, there are various types of medical insurance that you can be eligible to get depending on your individual situation. We’re going to take a look at each of these various types of insurance below so that you can get a better idea of which one is going to be the best fit for your health needs.

Health Maintenance Organization (HMO)
With this type of insurance plan, you’ll be given a strict network of medical providers and facilities that you can use. The insurance company will be billed directly by the provider, so there are no upfront costs other than your co-pay. Here are a few other things you should know about HMO plans:

  • Requires Little Paperwork
  • Need Referrals For Specialists
  • Less Freedom To Choose Your Healthcare Provider
  • Has Deductibles For Everything But Preventative Care
  • Co-Pay Or Coinsurance Necessary For Visits

Preferred Provider Organization (PPO)
A PPO plan is somewhat similar to an HMO in many ways. However, it’s important to note that there are still some differences that you should be aware of when assessing what health insurance plan is best for you. Here are some facts about PPOs that you should get to know:

  • Has A Large Network Of Providers
  • Out-Of-Network Visits Can Be Costly
  • Requires Filing Paperwork For Out-Of-Network Visits
  • No Specialty Doctor Referrals Necessary For Coverage

Exclusive Provider Organization (EPO)
The concept behind this plan is that it keeps your network simple and your expenses low. You can enjoy lower premiums than with other plans. However, you’ll be restricted to the doctors that you can see and have your visit covered by your insurance policy. Here are the key facts to know about an EPO health insurance policy:

  • Only Visits To Network Providers Are Covered (Except For Emergency Visits)
  • No Referrals Needed For Specialty Doctors
  • Lower Premiums Than Most PPOs
  • Requires Co-Pay Or Coinsurance
  • No Excess Filing Paperwork To Worry About

Point Of Service Plan (POS)
Next up we have the POS plan. This plan is a hybrid between the PPO and the HMO plans, which can be a major benefit for policyholders. Here are the key things you’ll need to know about the POS health insurance plan:

  • Coverage For In And Out Of Network Providers
  • Requires Referrals For Specialty Visits
  • Out Of Network Visits Get Reimbursed At A Lower Percentage Than In Network Visits
  • Co-Pay Or Coinsurance Is Required

Medicare Plans
There are various types of Medicare plans out there for you to choose from. These include Medicare Advantage Plans, Medicare Supplement Plans, Medicare Part D Plans. These services can differ depending on the type of Medicare Plan. There are four parts of the Medicare program which include:

  • Part A – Hospital / Inpatient Coverage
  • Part B – Medical / Outpatient Coverage
  • Part C – This is an alternative plan that covers both Part A and B as well as extra benefits.
  • Part D – Prescription Drug Coverage

Medicare Advantage Plans are considered Part C and are offered by a private company, usually for the benefit of their employees. Medicare Supplement Plans, also referred to commonly as Medigap Insurance, is additional private insurance you can purchase to cover gaps in your original Medicare benefits. One common supplemental type of insurance that people opt for is Medicare Part D Plans to cover the prescription medications they need.

What Isn’t Typically Covered With Medical Insurance?
As you learned above, health insurance is there to cover preventative health services, emergency services, maternity care, and prescription drugs. This type of insurance is intended to help protect the average citizen from exorbitant medical costs. However, it’s important to note that medical insurance doesn’t cover all your medical-related procedures.

Many health insurance companies will draw their line of coverage at what they deem not medically necessary procedures. This means that if the procedure you’re undergoing isn’t necessary to prevent, treat, or diagnose a condition or illness, then they won’t cover it. The most common types of procedures that aren’t covered under typical medical insurance include:

  • Infertility Treatment
  • Acupuncture
  • Weight Loss Surgery
  • Cosmetic Surgery

The Many Benefits Of Having Medical Insurance
Hopefully, you now have a very good idea of what medical insurance is and the various types of plans you have to choose from. A quick look online can help you to easily search through the varying health insurance programs and providers to find the right policy for you. If you’re still wondering if medical insurance is a worthwhile investment for you, here are some of the major benefits that you can gain from having this type of insurance in your life.

Safeguarding Your Financial Future
It’s no surprise to anyone that medical problems can turn into huge expenditures. Without an insurance policy to help pay for those expenses, you’ll find yourself in over your head with debt. According to MedicareWire.Com, one simple medical test can run in the thousands and leave your savings drained. For a monthly premium, you can get medical coverage that safeguards your financial future from unexpected high medical costs.

Peace Of Mind
When you become injured and cannot work, it can be a stressful time. Paying for all the medical visits and your prescription medication can stress you out even more unless you know that you have health insurance. A great medical insurance plan will provide you with much-needed peace of mind about your financial situation while you focus on getting better. Without insurance, your stress about financial problems can drastically hinder your ability to recover successfully.

Better Overall Health
Many studies have shown that those individuals who have health insurance tend to be in better health than individuals who don’t have insurance. This is simply due to the fact that those who are covered are more likely to go to their doctor in the event that they experience a problem. Plus, they’re more likely to go to regular preventative examinations as they know that their insurance policy will cover their medical expenses.

Avoid Tax Penalty
If you’ve been without health insurance, you know that tax time can be an extra burden. Those who don’t have coverage throughout the year will end up paying the government a penalty fee. By enrolling in a qualified health plan, you can eliminate having to pay this unnecessary tax penalty.

Negotiated Rates
When you get a bill for a medical visit when you don’t have insurance, it can make your head spin at some of the exorbitant fees that are passed along. Things like gauze pads can cost in the upwards of $70 for one visit. Simple medications like Tylenol can cost $1.50 per tablet. Compare this to the actual prices for these items at the store and you’ll be surprised at just how ridiculous some of these costs can be.

When you have health insurance, your provider will already have negotiated rates with the provider. These rates will be much lower than they charge those without insurance. This not only benefits the insurance company, but it helps you out too. This is by lowering the price of the doctor’s visit. Therefore, you’ll end up enjoying a smaller co-pay or coinsurance for your visit.

Access To Preventative Care
Most insurance companies are required by law to cover annual checkups and preventative care for their policyholders. This includes things like colonoscopies, cancer screenings, vaccinations, and mammograms. All of these should be provided without a co-pay from the policyholder. Without insurance, you’ll need to pay out of pocket for these preventative care options. Some of these, such as testing and vaccinations, can be extremely expensive and out of reach of many average citizens.

Ensures You Get Follow-Up Care
Regardless of the type of health insurance policy you have, you’ll always be able to get follow-up care after an injury or illness occurs. In some instances, you may have to go to your primary physician first to get a referral. In other types of insurance policies, you can go directly to the follow-up specialist without a referral. Without insurance, getting a follow-up visit can be difficult. Although hospitals will provide care regardless of your ability to pay, specialty places like physical therapy will not. Without a fair amount of money or the ability to create a payment plan, you can have difficulty getting follow-up care without insurance coverage.


Source: pixabay.com

Medical insurance is not anything new. Employers and private citizens have been utilizing this type of insurance policy for decades to help combat the rising cost of medical care. If you don’t currently have health insurance, hopefully, you now understand why it’s a necessity for your life. Now, since you understand the various options that you have when it comes to the type of health insurance policy that you can get, you can better pick one that fits your needs effectively.

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Why Getting Medical Insurance Is a Must
If you've been paying attention to politics over the last few years, health insurance has been a hot topic.
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