Haris Ashley
Medical insurance, also known as health insurance, is a type of insurance that covers the whole or part of the risk of a person incurring medical expenses. It is a plan or policy that covers a percentage of doctors' visits and hospital bills, helping to offset the costs of medical events, whether planned or unexpected. Medical insurance can be obtained through an employer or purchased individually, and it typically involves paying a premium every month in return for coverage of medical and surgical expenses. It is designed to provide peace of mind and financial security in case of unexpected medical costs.
| Characteristics | Values |
|---|---|
| Types of plans | Exclusive Provider Organization (EPO), Health Maintenance Organization (HMO), High-deductible health plans (HDHP) |
| What it covers | Regular office visits with your doctor, tests, urgent and emergency care, hospital stays, prescription drugs, medical equipment |
| Cost estimation tools | Some plans offer easy-to-use price transparency tools that can help estimate what you might pay out of pocket for a certain service at a certain location |
| Supplemental insurance policies | Help pay for out-of-pocket medical expenses such as copays and deductibles when a serious illness or accident happens |
| Whole Life Insurance premium | Based on the Level Benefit Plan individual rate for a female non-tobacco user in Alabama, age 55, with a $10,000 benefit amount |
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What You'll Learn
Types of health insurance plans
There are several types of health insurance plans, each with its own unique features and benefits. Here are some of the most common types:
Health Maintenance Organization (HMO) Plans:
HMOs are one of the most affordable types of health insurance plans, often featuring lower premiums and deductibles. They provide healthcare services through a network of healthcare providers, including doctors, hospitals, and specialists. With an HMO, you typically choose a primary care provider (PCP) who coordinates your care and refers you to specialists within the HMO network. HMO plans usually require you to use in-network providers, and you may have to pay more if you see an out-of-network doctor.
Preferred Provider Organization (PPO) Plans:
PPOs offer more flexibility in choosing healthcare providers. You pay less if you use providers in the plan's network, but you also have the option to use out-of-network doctors for an additional cost. PPOs may have deductibles, and you don't need a referral from a primary care doctor to see a specialist.
Exclusive Provider Organization (EPO) Plans:
EPOs are managed care plans that cover services only if you use doctors, specialists, or hospitals within the plan's network, except in emergencies. EPOs generally have higher out-of-pocket costs compared to other types of plans.
Point of Service (POS) Plans:
POS plans offer a combination of HMO and PPO features. You pay less if you use in-network providers, and you need a referral from your primary care doctor to see a specialist. POS plans may also have higher out-of-pocket costs for out-of-network providers, and they usually have more paperwork involved.
High Deductible Health Plans (HDHPs):
HDHPs are designed for those who want to pay less for their insurance premiums. These plans often have higher out-of-pocket costs, and you need to reach a certain deductible before the plan starts paying for your medical expenses. HDHPs are often used with Health Savings Accounts (HSAs) to help pay for current and future medical expenses on a tax-free basis.
Marketplace or ACA Plans:
These plans are sold on the health insurance Marketplace or Exchange. They focus on preventive care, cover pre-existing conditions, and provide benefits for doctor visits, prescriptions, and lab tests. Enrollment is typically during an established period.
Medicare and Medicaid:
Medicare is a federally funded program originally designed for individuals 65 and older, but it has expanded to include disabled people under 65 and those with special circumstances. Medicaid, on the other hand, is a federal and state program for low-income families, seniors, and individuals with disabilities. Eligibility for Medicaid is based on income standards, and it provides benefits such as long-term services and supports.
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What is covered by my insurance?
The coverage provided by your insurance will depend on the type of insurance you have and the insurance company. It is important to check with your insurance provider what is covered by your plan. Here are some questions you may want to ask your insurance provider:
- Does my insurance cover the type of treatment I want, and at what rate?
- How much is my co-pay and/or coinsurance, and how many appointments or days of treatment are covered per year?
- Do you have a list of preferred facilities or providers in my area?
- Do you have case managers (like a nurse or social worker) who can work with me for free?
In general, health insurance plans cover regular office visits with your doctor, tests, urgent and
If you are unsure about what type of insurance you have, you can refer to your insurance card, which should have a phone number on the back that you can call to ask about your coverage. You can also refer to your Summary of Benefits and Coverage (SBC), which lists the services covered by your plan and how much they cover.
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Out-of-pocket expenses
A deductible is the amount of money you are responsible for paying for your medical expenses before your insurance company starts paying on your behalf. For example, if you choose a plan with a $1,000 deductible, you will need to pay the first $1,000 of your medical bills yourself. Most insurance plans have different deductibles for different types of coverage. For instance, you might have to meet a $1,000 deductible before your insurance covers a hospital visit, but only a $250 deductible for prescription medication.
Coinsurance is a cost-sharing agreement between you and your insurance company. After paying the deductible, you are responsible for paying a certain percentage of your medical costs, as outlined in your policy. These percentages vary from plan to plan.
Monthly premiums are the regular payments you make to keep your health insurance active. They are typically paid as a lump sum or in installments throughout the duration of the policy. If you fail to pay your premium when it is due, your insurance policy may be cancelled.
It's important to note that out-of-pocket expenses can also include fees from providers outside your insurance network if your plan doesn't cover out-of-network care. Additionally, non-medical expenses related to healthcare, such as travel costs to a hospital, may also be considered out-of-pocket expenses.
To better understand your out-of-pocket expenses, you can review your insurance plan's Summary of Benefits and Coverage (SBC) or use cost estimation tools provided by your insurance company. These tools can help you estimate how much you might pay out of pocket for specific medical services.
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Supplemental insurance
There are several types of supplemental insurance plans, including accident insurance, cancer insurance, critical illness insurance, and hospital indemnity 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 indemnity insurance helps cover the costs of hospitalisation and may pay out a lump sum upon admission, followed by 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, but it is essential to carefully review the details of any policy to understand what is covered and what is not.
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Getting a replacement insurance card
There are different types of Marketplace health insurance plans, including Exclusive Provider Organization (EPO) and Health Maintenance Organization (HMO) plans. If you need a replacement insurance card, the process will depend on your insurance provider.
Blue Cross Blue Shield of Michigan
If you're a Blue Cross Blue Shield of Michigan Medicare plan member, you can log in to your online member account to order a new card, view a digital copy, or print a copy. You can also download the Blue Cross app to view your member ID card. If you don't have an online account, you can register on the website or call the Customer Service number on your explanation of benefits statement.
Civil Service in New York State
If you're a New York State employee, you can order a replacement card by logging into the Civil Service website MyNYSHIP at www.cs.ny.gov/mynyship. Alternatively, if your agency is a BSC customer, you can contact the BSC by phone, email, mail, or fax and include your current address.
Other Insurance Providers
If you have a different insurance provider, you may need to contact them directly to request a replacement card. You can usually find their contact information on your insurance card or on the provider's website. In some cases, you may be able to access your account online and order a replacement card through their website or app.
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Frequently asked questions
Medical insurance is a type of insurance that covers medical expenses, including doctor visits, tests, prescriptions, hospital stays, and medical equipment.
There are several types of medical insurance plans, including Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs). HMOs typically limit coverage to doctors who work for or are contracted with the HMO. EPOs are managed care plans that only cover services from doctors, specialists, or hospitals within the plan's network, except in emergencies.
You can contact your insurance company's Member Services team or refer to your Summary of Benefits and Coverage (SBC) document, which lists the services covered and their costs. You can also use your plan's cost estimation tools to understand what you might pay out of pocket for specific services.
Different plans cover different doctors, specialists, and clinics. You can check if your doctor is covered by signing in to search your insurance network or contacting your insurance company.
Supplemental health insurance is an additional policy that helps pay for out-of-pocket medical expenses, such as copays and deductibles, in the event of a serious illness or accident. It does not constitute comprehensive health insurance coverage and is meant to supplement a primary insurance plan.
