Jane Dotson
Insurance is a means of protection from financial loss, and there are many types of insurance available, from health insurance to life insurance. Some insurance plans are tailored to individuals and families, while others are designed for service members. Some insurance companies also offer supplemental insurance to help cover out-of-pocket expenses that primary insurance may not cover. When it comes to insurance, it's important to understand the specific coverage provided by your plan, as well as any limitations or exclusions.
| Characteristics | Values |
|---|---|
| Insurance provider | UnitedHealthcare, Aetna, Veterans Affairs |
| Type of insurance | Health insurance, life insurance, supplemental insurance |
| Who is it for? | Individuals, families, students, self-employed, employers, employees, service members, veterans |
| What does it cover? | Health and wellness, dental screenings, vision care, prescription drugs, mental health services, substance use disorder services, hospitalization, emergency services, maternity care, preventive care, behavioural health conditions, out-of-pocket expenses, critical illnesses, funeral expenses, pet insurance |
| What are the costs? | May need to meet deductibles before coverage starts, may have annual/lifetime dollar limits on health benefits, may have additional membership fees |
| What are the benefits? | Fast and flexible coverage, ability to combine insurance plans, choice of coverage level, right to appeal coverage decisions, independent external review of coverage denials |
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What You'll Learn
Servicemembers' Group Life Insurance (SGLI)
- Active-duty member of the Army, Navy, Air Force, Space Force, Marines, or Coast Guard
- Commissioned member of the National Oceanic and Atmospheric Administration (NOAA) or the U.S. Public Health Service (USPHS)
- Cadet or midshipman of the U.S. military academies
- Member, cadet, or midshipman of the Reserve Officers Training Corps (ROTC) engaged in authorized training and practice cruises
- Member of the Ready Reserve or National Guard, assigned to a unit, and scheduled to perform at least 12 periods of inactive training per year
Those with SGLI coverage pay a monthly premium that is automatically deducted from their base pay. The current basic SGLI premium rate is $0.06 per $1,000 of insurance coverage, and the premium includes an additional $1 per month for Traumatic Injury Protection coverage (TSGLI).
When a service member leaves the military, they have the option to convert their SGLI coverage to a permanent, individual insurance policy within 120 days from their date of discharge without proof of good health. They may also be able to keep their coverage for up to 2 years after leaving the military at no cost if they meet certain requirements. Additionally, they can apply for Veterans' Group Life Insurance (VGLI) within 1 year and 120 days from their date of discharge, for up to the amount of coverage they had through SGLI.
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Medicare and other health insurance
Medicare is a health insurance program for people over the age of 65, and for some people under 65 with disabilities. It is available to US citizens or permanent residents who have lived in the US for at least five years. Medicare has different parts, known as Part A, Part B, Part C, and Part D, which cover different services.
Part A is hospital insurance, which covers inpatient care in hospitals, skilled nursing facilities, and hospice facilities, as well as some home health care services. Most people do not have to pay a premium for Part A. Part B is medical insurance, which covers certain doctors' services, outpatient care, medical equipment, and some preventative services. There is usually a monthly premium for Part B, which may be deducted from your Social Security, Railroad Retirement, or Civil Service Retirement benefits.
Once you have signed up for Part A and Part B, you can choose between Original Medicare and Medicare Advantage (Part C). Original Medicare is fee-for-service, meaning you can choose any doctor who accepts Medicare. Medicare Advantage Plans are offered by Medicare-approved private companies and must follow rules set by Medicare. Most include drug coverage (Part D). There are several types of Medicare Advantage Plans, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
If you have Medicare and other health insurance, such as from an employer or union, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage and sends the rest of the balance to the "secondary payer". If the secondary payer doesn't cover the remaining balance, you may be responsible for the rest of the costs.
You can also purchase Medicare Supplement Insurance, known as Medigap, from private companies to help pay your share of costs in Original Medicare. Medigap policies are standardized, and in most states, they are named by letters, like Plan G or Plan K. The benefits are the same no matter which insurance company sells it, and the price is the only difference between policies with the same letter. Generally, you need Part A and Part B to buy a Medigap policy.
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Supplemental insurance
There are several types of supplemental insurance plans available, including accident insurance, cancer insurance, critical illness insurance, and hospital insurance. Accident insurance provides coverage for injuries caused by an accident and typically offers a lump-sum payout that can be used for medical treatment or indirect expenses such as hotel stays and transportation. Cancer insurance helps protect against the financial burden of cancer treatments, while critical illness insurance offers a lump-sum payout after a qualifying diagnosis of a serious illness covered by the plan. Hospital insurance, also known as hospital indemnity insurance, helps cover the costs of hospitalisation and may pay out a lump sum upon admission and then a per-day amount.
When considering supplemental insurance, it is important to evaluate your health history, family needs, and financial situation. Supplemental insurance can provide peace of mind and help ensure your family's financial security during difficult times. However, it is also important to be aware of the coverage limits and potential denial of coverage based on health status or pre-existing conditions.
To decide if supplemental insurance is right for you, carefully review the details of the policy, including the terms, coverage limits, and any exclusions or limitations. Assess your health and lifestyle needs to determine if the additional coverage is worth the cost. Supplemental insurance can be a cost-effective way to prepare for unexpected events and ensure you have the resources to get back on your feet.
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Health insurance plans
There are several types of health insurance plans available, each with its own unique features and benefits. Here is an overview of some common health insurance plans:
Bronze, Silver, Gold, and Platinum Plans: These plans are categorized by metal tiers, with Bronze offering the least coverage and Platinum providing the most. These categories indicate how costs are shared between you and your plan, but they do not reflect the quality of care. Higher-tier plans generally come with higher monthly premiums but lower out-of-pocket expenses when you require medical services.
Health Maintenance Organization (HMO) Plans: HMO plans typically limit coverage to a network of contracted doctors and healthcare providers. They usually do not cover out-of-network care except in emergencies. HMOs often require individuals to live or work within their service area to be eligible for coverage. Additionally, referrals from a primary care physician are generally needed to see specialists.
Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility, allowing individuals to use both in-network and out-of-network healthcare providers. While in-network providers are typically more affordable, individuals can choose out-of-network options for an additional cost, without always needing a referral. PPO plans generally have lower monthly premiums but higher out-of-pocket costs when compared to HMOs.
Point of Service (POS) Plans: POS plans are similar to PPOs in that they offer a network of preferred providers with whom they have negotiated rates. Individuals typically pay less when using in-network providers and may pay higher costs for out-of-network services. POS plans also usually require referrals from a primary care physician to see specialists.
Exclusive Provider Organization (EPO) Plans: EPO plans are a type of managed care plan that covers services only when received from doctors, specialists, or hospitals within the plan's network, except in emergency situations. EPO plans generally do not cover out-of-network care.
Catastrophic Health Plans: These plans are typically designed for individuals under 30 years old and have lower monthly premiums but very high deductibles. Catastrophic plans are meant to provide coverage for unexpected, high-cost medical events, such as serious accidents or illnesses. They also cover a limited number of primary care visits and preventive care services for free, even before meeting the deductible.
When choosing a health insurance plan, it is essential to consider your specific needs, budget, and healthcare preferences. Additionally, it is worth noting that certain insurance brands, such as Aetna, may offer multiple types of plans with varying levels of coverage and benefits. Other factors to consider include the specific doctors, medical facilities, and prescription drugs covered by each plan.
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Insurance coverage
Health insurance plans, for example, can vary greatly. Some providers, like Aetna, offer different tiers of coverage, with varying subtypes. These tiers determine what is and isn't covered by your plan. Aetna also provides Clinical Policy Bulletins (CPBs) that outline their clinical policies and help determine medical necessity for coverage decisions, which are made on a case-by-case basis. Members have the right to appeal coverage decisions and may be able to request an independent external review of coverage denials.
UnitedHealthcare also offers health insurance plans with different coverage options. They emphasize that every health plan is unique and encourage members to review their benefits to understand their specific coverage. UnitedHealthcare also offers supplemental plans to boost coverage for services not included in the primary medical insurance plan, such as dental and vision care.
In the case of Medicare, if you have other health insurance, each type of coverage is called a "payer." The "primary payer" pays up to its limit, and the remaining balance is sent to the "secondary payer." If the secondary payer doesn't cover the remaining balance, you may be responsible for the remaining costs.
Supplemental insurance companies like Aflac provide additional coverage for expenses that your major medical insurance doesn't cover. This can include help with out-of-pocket expenses, emergency treatment, critical illnesses, and more.
It is always important to carefully review the details of your insurance plan to understand your coverage and any limitations or exclusions.
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Frequently asked questions
Servicemembers’ Group Life Insurance (SGLI) offers low-cost term coverage to eligible active-duty service members of the Army, Navy, Air Force, Space Force, Marines, or Coast Guard, or commissioned members of the National Oceanic and Atmospheric Administration (NOAA).
Medicare is a type of health insurance. If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage and then sends the rest of the balance to the "secondary payer". If the "secondary payer" doesn’t cover the remaining balance, you may be responsible for the remaining costs.
Aetna is a health insurance plan provider. Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, and medical necessity determinations in connection with coverage decisions are made on a case-by-case basis.
