What health insurance is best for you? The answer to that question depends on your understanding of what health insurance is and what your particular needs are. First, it is not discounted health care. Generally speaking, insurance is a kind of risk management. Your premium is your monthly payment to the company to assume the risk of expense. In one sense, this is a sort of gambling. In this case, the health insurer is betting that you will not need care, and the premium you pay every month is your hedge to offset the consequences should you face large medical expenses. Your health insurance benefits are what you get when the company “loses” and has to pay out.
Now that we know that a health insurance policy is a way to manage risk, it is important to understand that there are a number different kinds of agreements, or policies, available depending on your needs. Generally, the subject of health insurance brings to mind questions about doctor and hospital care available for individuals and families through privately purchased policies, and/or employees through an employer group health insurance plan. When choosing a health insurance policy, you (or an employer) must decide what your tolerance for risk is and how much risk you want managed. To that end, there are many private companies selling insurance plans.
Some well-known health insurance company names that you might encounter when researching policies include, Assurant, Anthem, Blue Cross, Aetna, Cigna, Banker’s Life, Mutual of Omaha, United Health Care, Humana, Kaiser, and Tonik. This is really just the tip of the iceberg, and the point of listing these names is only to show you that there are many, many insurance companies all offering their own benefit packages and prices. When you choose a plan, you are choosing one health insurance company to be the payer on your health insurance costs. The way this works is that your doctor submits a bill (called a claim) to the insurance company for services provided, and the company reimburses the doctor an agreed upon rate. How much the insurer pays and how much you pay as your share of costs (deductibles and copayments) depends on the agreements set forth in the policy.
Is there such a thing as single payer health insurance? The answer is both yes and no. In the United States the insurance program that most closely approximates a single payer is the Federal health insurance program for retired individuals age 65 and above. This program is called Medicare and became law in 1965. Although the government manages Medicare, it contracts with private insurance companies to handle the day to day operational logistics of administration. So you see, even though the government is the single payer, it still involves the private insurance industry. The Federal government has gone even further involving private insurance by creating the Medicare Advantage Plan program, which essentially allows private insurance payers to manage Medicare benefits through private, managed care plans.
Health insurance choices can seem to be overwhelming. After all, there are not only many different insurance companies but many different kinds of policies as well. Some examples include, supplemental insurance designed to supplement or add on to an already existing health insurance policy; there is dismemberment insurance, temporary health insurance, hospital only insurance, disease specific health policies, and policies designed to pay only when your total out-of-pocket expenses reach a certain limit. The question of course, is how to do you choose?
How you choose a health insurance policy depends on your assessment of your costs, needs, and circumstances. If you need doctor and hospital coverage for specific period of time, then you might seek a temporary policy from Blue Cross or Humana, for example. If you need family health coverage, then you might, hypothetically, seek a comprehensive medical plan from Wellmark, Aetna, or John Deere. Some people take out a policy, to provide another example, from United Healthcare (or some other insurer) to pay only in the event of hospitalization as result of cancer. Other people, who work in a high risk environment, might take out a policy to pay in the event of dismemberment occurring under certain, specified circumstances. The policies can be quite specific and written to answer your specific needs.
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