Getting the right healthcare for you and your family can often be a huge challenge. Taking into consideration pertinent factors like accessing competent physicians, healthcare centers with the right equipment and medicine, and more importantly the costs that you will be expected to meet. Most ordinary individuals might require relatively infrequent medical attention, while others, depending on their health conditions, need more visits to the hospital. However, everyone from time to time has to deal with unexpected health challenges, which can often necessitate a substantial amount of money.
It is, thus, wise to have the foresight to take appropriate measures to ensure that whatever predicament comes your way, you will always be prepared. One of the best ways of doing this is by acquiring a suitable health insurance cover, which will infinitely lower your medical expenses.
Figuring out the right health insurance plan that will meet your distinct needs, isn’t as easy as it might appear, and there are various factors one needs to consider. This article will attempt to elaborate on the different types of medical insurance plans available.
What kind of healthcare plans do insurance firms offer?
In essence there are 4 common types of medical insurance plans, which are bronze, silver, gold, and platinum. It is important to note that under the Affordable care act, all these plans meet the same essential health benefits, which among others include coverage for:
• Chronic ailments treatment
• Maternity care
• Occupational & physical therapy
• Preventive care
• Prescription drugs
• Emergency services
• Addiction treatment
What primarily distinguishes one plan from the other is often based on several factors, which are:
This happens to be the prerequisite monthly payment any medical insurance policyholder has to meet, despite of having or having not received medical care. The factors that determine how much premium you will pay include: your age, whether you smoke, your location, number of people you want to be covered in the policy, among others.
This is the mandatorily charge you will have to foot before the health insurance plan you have taken can begin to chip in.
Copayment is usually a fixed rate that you pay for receiving healthcare benefits covered in your health insurance plan. Naturally, this fee normally varies for different medical care. For instance, a normal visit to your physician will generally be lower than an emergency room visit.
This is your allotted share of medical care expenses, and is normally a fixed portion of the total amount for any medical service you receive. This charge is deducted after your expenses reach the limit of the deductible you opt for.
Out of pocket maximum
This happens to be the highest amount (normally within a year) you will meet prior to the health insurance plan you’ve enrolled on covers your medical expenses. It is important to bear in mind this omits any expense that isn’t covered in your distinct medical insurance plan.
The difference between the costs these 4 plans; bronze, silver, gold, platinum, normally cover is calculated from their actuarial value. The higher the plan (gold & platinum) the higher the total amount such a health insurance policy covers for your medical needs.
This invariably means that you will be liable to pay lower deductibles, copayment, and coinsurance. The catch, however, in enrolling on a higher medical insurance plan is that you will be necessitated to foot exorbitant premiums. A bronze plan covers roughly 60% of all your medical expenses covered in your policy. Silver plans cover 70% of the same, while gold meets 80% and a platinum plan foots 90%.
Choosing the right type of medical insurance plan
Depending on you and your family’s distinct needs, you can be in a position to choose the best share of cost you wish to meet. Some plans offer low deductibles, which means that you will be required to meet steep coinsurance, and copayment. Conversely, you can opt for a high deductible, which will lower the other expenses you will have to meet.
Deciding on the right plan, with this knowledge in mind, can be infinitely simpler. Should you be an individual that requires frequent medical attention, a gold or platinum plan will be right down your alley. As it meets a considerably large portion of your medical expenses ( 80% and 90% respectively). On the other hand, if you and yours are generally in good health, you can pick a bronze or silver plan, which will keep your deductible and premiums lower.
Should you be shopping for a medical insurance policy in your state’s marketplace, these plans often fall under 4 distinct categories of healthcare providers. These are:
• Health maintenance organizations (HMOs)
• Preferred Provider organizations (PPOs)
• Point of service (POS)
• High deductible health plans(with health savings accounts (HSAs))
These categories of healthcare insurance plans offer varying benefits the most prominent of which are; the right to select your own healthcare providers, and access to more preventive care.
For instance HMOs plans proffer very little freedom in picking your preferred healthcare providers, while on the flipside it offers much more preventive care and a primary care physician. PPOs on their side offer a good opportunity to efficiently manage your healthcare expenses.
POS plans integrate both features of HMOs and PPOs. Finally, HDHP/ Health Savings Account’s main benefit is your getting a health saving account. This naturally, connotes that you can be in a position to put extra money in it, which can come in handy when you and your family’s future medical bills.
For those individuals that might be in tight financial circumstances there are 2 subsidies that can assist them in securing affordable medical care insurance. These are:
• The cost sharing reduction subsidy, which significantly lowers the deductibles, copayments and coinsurance. This applies for individuals whose income falls under 100%-400% of the federal poverty level ($11,490 – $28,725) and you must purchase a silver plan for it to be effective.
• The Advanced Premium Tax Credit subsidy, which substantially lowers the amount of premium such persons pay. The only stipulation is your income being 100% -400% ($11,490 – $45,960).
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