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Health Insurance...a constantly growing issue for everyone in our society. Can you get it? Can you afford it? What kind of coverage can you get?  If you have ever been sick or injured, you know how important it is to have health coverage. But if you're confused about what kind is best for you, you're not alone. There are many kinds of health insurance. Tegeler & Associates can work with you to find an option that best meets your needs.

The term health insurance refers to a wide variety of insurance policies. These range from  policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care. Even disability insurance—which replaces lost income if you can’t work because of illness or accident—is considered health insurance, even though it’s not specifically for medical expenses.

Today, when people talk about broad health care coverage, instead of using the term "major  medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you’ll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.

While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.

Here are some of the things to look at when choosing and comparing health insurance plans and descriptions of some of the plans that are available:

Inpatient hospital services Outpatient surgery Physician visits (in the hospital) Office visits Skilled nursing care Medical tests and X-rays Prescription drugs Mental health care Drug and alcohol abuse treatment Home health care visits

Rehabilitation facility care Physical therapy Speech therapy Hospice care Maternity care Chiropractic treatment Preventive care and checkups Well-baby care Dental care Other covered services

1. Fee-for-Service
2. Managed Care
3. Long Term Care insurance
4. Hospital - Surgical Policies
5. Catastrophic Coverage
6. Specified or Dread Disease Policy
7. Hospital Indemnity Insurance
8. Medicare Supplement Insurance
9. Disability Insurance

1. Fee-for-Service:

This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient—you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for "covered" medical expenses, the ones listed in your  benefits summary. When a service is covered under your policy, you can expect to be reimbursed for some, but generally not all, of the cost. How much you will receive depends on the provisions of the policy on coinsurance and deductibles.

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2. Managed Care:

The three major types of managed care plans are health maintenance organizations (HMOs),  preferred provider organizations (PPOs), and point-of-service (POS) plans.

Managed care plans generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for each service that you receive, your coverage is paid in advance. This is called prepaid care.

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3. Long Term Care Insurance:

Long-term care policies cover the medical care, nursing care, and other assistance you might need if you ever have a chronic illness or disability that leaves you unable to care for yourself for an extended period of time. These services generally are not covered by other health insurance. Unless you have a long-term care policy, you are not covered for long-term care expenses under Medicare and most other types of insurance. 

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4. Hospital - Surgical Policies:

Sometimes called basic health insurance, provide benefits when you have a covered condition that requires hospitalization. These benefits typically include room and board and other hospital services, surgery, physicians’ non surgical services that are performed in a hospital, expenses for diagnostic X-rays and laboratory tests, and room and board in an extended care facility.

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5. Catastrophic Coverage:

This pays hospital and medical expenses above a certain deductible; this can provide additional protection if you hold either a hospital-surgical policy or a major medical policy with a lower-than-adequate lifetime limit. These policies typically contain a very high deductible ($15,000 or more) and a maximum lifetime limit high enough to cover the costs of catastrophic illness.

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6. Specified or Dread Disease Policy:

These provide benefits only if you get the specific disease or group of diseases named in the policy. For example, a policy might cover only medical care for cancer. Because benefits are limited in amount, these policies are not a substitute for broad medical coverage. Specified disease policies are not available in every state.

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7. Hospital Indemnity Insurance:

This coverage pays you a specified amount of cash benefits for each day that you are hospitalized, generally up to a designated number of days. These cash benefits are paid directly to you, can be used for any purpose, and may be useful in meeting out-of-pocket expenses not covered by other insurance.

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8. Medicare Supplement Insurance:

Sometimes called Medigap or MedSup, is private insurance that helps cover some of the gaps in Medicare coverage. Medicare is the federal program of hospital and medical insurance primarily for people age 65 and over who are not covered by an employer’s plan. But Medicare doesn’t cover all medical expenses. That’s where MedSup comes in. All Medicare supplement policies must cover certain expenses, such as the daily coinsurance amount for hospitalization and 90 percent of the hospital charges that otherwise would have been paid by Medicare, after Medicare is exhausted. Some policies may offer additional benefits, such as coverage for preventive medical care, prescription drugs, or at-home recovery. People who are 65 or older can buy Medicare supplement insurance without having to worry about being rejected for existing medical problems, so long as they apply within six months after enrolling in Medicare.

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9. Disability Insurance:

Disability insurance provides you with an income if illness or injury prevents you from being able to work for an extended period of time. It is an important but often overlooked form of insurance.

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