The purpose of health insurance is to protect you from the alarming cost of medical care by providing you with insurance coverage for specified health and medical care services. Generally, you will pay a monthly premium, a deductible, and co-payments for services you receive. The cost for insurance is significantly less than if you had to pay for medical care out of your pocket. There are three basic types of health insurance, fee for service, consumer-directed, and managed care. These basic types of insurance plans cover hospital, medical, and surgical expenses, and depending on the particular plan you choose, possibly prescription drugs, mental/behavioral care, and dental.
A fee for service plan means the health care professional you choose will be paid a fee for each service provided to you. You can choose your own doctor and the insurance claim can be filed by either the doctor or the patient. A managed care plan will provide coverage to their members and offers incentives for patients who choose doctors participating in the plan’s network. The 3 types of managed care plans are HMOs, PPOs, and POS plans.
An HMO allows you to receive medical care through a network of participating physicians. You will generally select a primary care doctor, who will then refer you to a specialist when necessary. A PPO combines various features of an HMO and a fee for service plan. Members can choose from network doctors and pay lower upfront expenses, or choose any doctor they desire and pay more out of pocket expenses. A consumer-directed health plan gives members more choices and options in making health care decisions. Consumer-directed plans include a health account or fund designated for health care expenses. At the end of each year, unused funds will roll over to the next year.
A health insurance premium is the fee paid to the insurer to purchase health coverage. Premiums can be paid monthly, quarterly, or annually. Deductibles are the amount you will pay for covered services within a certain time frame, according to the terms of your plan, before you will be entitled to insurance benefits. Members with a high deductible may have to pay the first one thousand dollars of yearly medical expenses before the insurance would begin to pay, and those with a higher or lower deductibles would pay more or less, depending on the particular amounts specified in their plan. A co-payment is a stated amount or percentage that must be paid by the member along with each doctor visit, medical procedure, or prescription. For example, if your specified co-payments are $25, you will pay the first $25 of each doctor visit and your insurance would cover additional charges. Most insurance plans specify a different co-payment amount for prescriptions, doctor visits, and hospital or surgical care.
In choosing which type of health insurance plan is right for you, you must consider the affordability of doctor visits and hospital care, the amount of the monthly premium, the amount of the deductibles, and the amount of the co-payments. Make sure the plan you chose offers coverage for services you will actually use such as doctors, prescriptions, laboratory costs, treatment for preexisting conditions, and out-of-network care. Check the rating of the insurance company in question, the number of patient complaints in the past year, doctor drop out rates if the insurance plan includes a network, and the number of members who have dropped out of the plan in the past year. Health insurance that is subsidized by your employer is generally the least expensive, but if your employer does not offer health insurance, you should consider an individual health insurance policy. The cost of medical care is far too expensive to risk not having health insurance.
Lengo la bima ya afya ni kukukinga na gharama ya kuogopesha ya huduma za matibabu kwa kukupa bima ya huduma maalum za afya na huduma za matibabu. Kwa ujumla, utalipa malipo ya kila mwezi, malipo ya kibinafsi, na malipo ya pamoja kwa ajili ya huduma unazopokea. Gharama ya bima ni ya chini sana kuliko ikiwa unalazimika kulipa huduma za matibabu kutoka mfukoni mwako. Kuna aina tatu za msingi za bima ya afya, ada kwa ajili ya huduma, watumiaji-kuelekezwa, na kusimamiwa huduma. Aina hizi za msingi za bima hufunika gharama za hospitali, matibabu, na upasuaji, na kulingana na mpango maalum unaochagua, labda dawa za dawa, huduma ya akili na tabia, na meno. Mfumo wa malipo ya huduma unamaanisha kwamba mtaalamu wa huduma ya afya unayechagua atapwa ada kwa kila huduma inayotolewa kwako. Unaweza kuchagua daktari wako mwenyewe na madai ya bima yanaweza kufanywa na daktari au mgonjwa. Mpango wa huduma inayosimamiwa utatoa chanjo kwa wanachama wao na hutoa motisha kwa wagonjwa ambao huchagua madaktari wanaoshiriki katika mtandao wa mpango. Aina tatu za mipango ya huduma za usimamizi ni HMO, PPO, na mipango ya POS. HMO inakuwezesha kupata huduma za matibabu kupitia mtandao wa madaktari wanaoshiriki. Kwa kawaida utachagua daktari wa huduma ya msingi, ambaye kisha atakuelekeza kwa mtaalamu inapohitajika. AOP ni mpango wa huduma ya malipo ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma ya huduma. Wanafunzi wanaweza kuchagua kutoka kwa madaktari wa mtandao na kulipa gharama za chini za awali, au kuchagua daktari yeyote wanaotaka na kulipa zaidi nje ya gharama za mfukoni. Mpango wa afya unaoelekezwa kwa watumiaji huwapa wanachama chaguzi na chaguzi zaidi katika kufanya maamuzi ya huduma ya afya. Mipango inayoelekezwa kwa watumiaji inajumuisha akaunti ya afya au mfuko uliowekwa kwa ajili ya gharama za huduma za afya. Mwishoni mwa kila mwaka, fedha zisizotumiwa zitaingizwa katika mwaka uliofuata. Kiwango cha bima ya afya ni ada inayolipwa kwa mtoa bima kununua bima ya afya. Malipo ya bima yaweza kulipwa kila mwezi, kila robo mwaka, au kila mwaka. Deductibles ni kiasi cha malipo ya huduma zilizofunikwa ndani ya muda fulani, kulingana na masharti ya mpango wako, kabla ya kuwa na haki ya faida ya bima. Wanachama wenye deductible ya juu wanaweza kulipa dola elfu moja ya kwanza ya gharama za matibabu ya kila mwaka kabla ya bima kuanza kulipa, na wale wenye deductibles ya juu au ya chini watalipa zaidi au chini, kulingana na kiasi maalum kilichoainishwa katika mpango wao. Mshahara wa pamoja ni kiasi au asilimia iliyowekwa ambayo lazima ilipewe na mwanachama pamoja na kila ziara ya daktari, utaratibu wa matibabu, au dawa. Kwa mfano, ikiwa malipo yako ya pamoja ni $ 25, utalipa $ 25 ya kwanza ya kila ziara ya daktari na bima yako itashughulikia malipo ya ziada. Mipango mingi ya bima huonyesha kiasi tofauti cha malipo ya pamoja kwa ajili ya dawa, ziara za daktari, na utunzaji wa hospitali au upasuaji. Ili kuchagua aina ya bima ya afya inayofaa wewe, lazima uzingatie uwezo wa gharama za ziara za daktari na huduma za hospitali, kiasi cha malipo ya kila mwezi, kiasi cha deductibles, na kiasi cha malipo ya pamoja. Hakikisha mpango unaochagua unatoa chanjo kwa huduma utakazotumia kama vile madaktari, dawa, gharama za maabara, matibabu ya hali zilizopo hapo awali, na huduma nje ya mtandao. Angalia kiwango cha kampuni ya bima inayohusika, idadi ya malalamiko ya wagonjwa katika mwaka uliopita, viwango vya kuacha daktari ikiwa mpango wa bima unajumuisha mtandao, na idadi ya wanachama ambao wameondoka kwenye mpango katika mwaka uliopita. Bima ya afya inayodhaminiwa na mwajiri wako kwa ujumla ni ya bei nafuu zaidi, lakini ikiwa mwajiri wako haitoi bima ya afya, unapaswa kuzingatia sera ya bima ya afya ya mtu binafsi. Gharama ya matibabu ni ghali sana kuhatarisha kutokuwa na bima ya afya.