Understanding Basic Health Insurance Coverage

Today more than ever before, health insurance coverage is essential in providing your family with the health security they need should anything happen. Generally, good health insurance coverage will include medication, consultations with doctors, hospitalization and hospital stays. Some health insurance coverage may also include diagnostic and treatment procedures.

There are several basic health insurance coverage plans to consider. In a managed care plan the insurance company offers its own doctors and hospital affiliations. The disadvantage of managed care health insurance coverage is that you’re often required to pay an additional fee should you prefer to visit your own doctor or be admitted to the hospital of your choice.

A Fee-of-Service plan is a health insurance coverage plan in which the company splits the cost of the doctors and hospital bills with the insured. The insured pays the insurance company a monthly premium, while the insurance company pays a portion of doctor and hospital expenses. Fee-of-service plans provide either basic coverage or major medical coverage. A basic fee-of-service plan covers the hospital room and hospital care, plus some additional hospital services such as x-rays and medications. Basic coverage also includes the cost of surgery and some doctor visits. A major medical fee-of-service plan is designed to cover the cost of long term care and major illness.

Next is the Health Maintenance Organization plan, commonly referred to as an HMO. Services, such as doctor’s visits, hospital stays, surgery, diagnostic tests, etc., are fulfilled by providers under contract with the HMO. The insured, therefore, generally does not have the freedom to choose his or her own doctors or hospital. Typically, the insured is assigned to a primary care provider and must go through this provider in order to be referred to other doctors or specialists (who are also contracted with the HMO in most cases) when necessary.

Medicare is a national health insurance program for people 65 years of age and older, certain younger disabled people, and people with permanent kidney failure. Medicare is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Part A helps pay for care in a hospital and a skilled nursing facility, and for home health and hospice care. Part B helps pay doctor bills, and for outpatient hospital care and other medical services not covered by Part A. You do not have to pay a monthly premium for Part A if you or your spouse worked for at least 10 years in Medicare covered employment, and you are 65 years old and a citizen or permanent resident of the United States. Everyone who enrolls in Medicare Part B must pay a premium.

COBRA isn’t a health insurance plan, but a government effort to protect people from losing their health benefits in certain situations. Passed in 1986, the Consolidated Omnibus Budget Reconciliation Act (COBRA) requires most group health plans to provide a temporary continuation of group health coverage that might otherwise be terminated. Situations that are covered by COBRA include the death of a covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, divorce, or legal separation from a covered employee, a covered employee’s becoming entitled to Medicare, and a child’s loss of dependent status (and therefore coverage) under the plan. COBRA generally applies to all group health plans maintained by private-sector employers (with at least 20 employees) or by state and local governments. The law does not apply to plans sponsored by the Federal government or by churches and certain church-related organizations.

There are a wide variety of health insurance coverage plans available to most people. A little research and working with either your employer or insurance agent will help you find the perfect plan for you and your family.