Comparing Policies
Besides the differences in state mandates, in premiums to be paid, and in yearly deductibles to be met, there are several other ways that health insurance policies can differ. You should consider the following factors when comparing policies:
- Co-payment. The co-payment amount is the percentage of covered expenses that you must pay. If the policy provides for a 10 percent co-payment, you will be reimbursed for 90 percent of your covered expenses; if it provides for a 20 percent co-payment, you will be reimbursed for 80 percent of your covered expenses.
- Limitation on yearly per-person outlay. This represents the maximum amount of unreimbursed expenses (such as $2,000) that you would have to pay for each covered individual in any one year. It includes the amount of your deductible, and a portion of the co-payments made by you during the year.
- Coverage for type of care. Policies often apply different co-payment amounts to the following: hospital rooms and doctor fees, surgical procedures, dental procedures, mental health services and out-patient care.
Effects of health care reform. The enactment of the Patient Protection and Affordable Care Act and related legislation heavily regulates the insurance industry, instituting benefit and coverage mandates. Except for grandfathered plans, it mandates that by 2014, all qualified health benefit plans offer at least an "essential health benefits package" as defined by the Secretary of Health and Human Services.
For more information, including the latest health care reform developments, visit the government's health care website.
Keeping in mind the components mentioned above, here's a menu of health coverage plans you'll have to choose among:
- Fee-for-Service (Indemnity) Health Insurance
- Preferred Provider Organizations (PPOs)
- Health Maintenance Organizations (HMOs)
- Major Medical (Catastrophic) Insurance
- Dental Insurance
- Vision Insurance
- Health Savings Accounts (HSAs)
- Medicare/Medicaid
- Long-Term Care Insurance
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