April 17, 2021

Health Insurance FAQ's

Q: Why should I have Health Insurance?
A: Based on the cost of health care, if you do not have medical insurance to help pay bills, a serious injury or illness can be financially devastating to you and your family. If you do not have coverage, have too little or the wrong type of coverage, you can be exposed to high costs. You will not be protected.

Q: What types of Health Insurance are available?
A: Major Medial Plans - This type of policy is usually effective in covering serious illness or injury where costs are high. Hospital care, drugs, and doctor's visits, are usually covered. These benefits can be delivered in different ways:

  • Indemnity Plans - Typically have a deductible. Once your covered expenses exceed the deductible amount, benefits usually are paid as a percentage of actual expenses, often 80%. These plans usually provide the most flexibility in choosing where to receive care.
  • Preferred Provider Organization (PPO) Plans - Insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to receive care from a doctor or hospital that is not a preferred provider, but you will probably have to pay a higher deductible or co-payment.
  • Health Maintenance Organization (HMO) Plans - You choose a primary care physician (PCP) from a list of network providers. Your PCP is responsible for managing all of your health care. If you need care from any network provider other than your PCP, you may need to get referral from your PCP to see that provider.
  • Point of Service (POS) plans - Hybrid of the PPO and HMO Plans. They provide more flexibility than HMOs, but do require you to select a primary care physician (PCP). Like a PPO, you can go to an out-of-network provider and pay more of the cost. However, if the PCP refers you to an out-of-network doctor the health plan will pay the cost.
Limited Benefit Plans - Provide limited coverage for a particular health care setting, ailment or disease. These are some of the options available: 
  • Basic Hospital Expense Coverage - Covers a period of usually not less than 31 days of continuous in-hospital care and certain hospital outpatient services.
  • Basic Medical-Surgical Expense Coverage - Covers costs associated with a necessaary surgery, including a certain number of days (usually not less than 21 days) of in-hospital care.
  • Hospital Confinement Indemnity Coverage - Covers a fixed amount (usually not less than $40) for each day that you are in a hospital. The benefits paid are not based on your actual expenses.
  • Accident Only Coverage - Covers death, dismemberment, disability or hospital and medical care caused by an accident. Specified accident coverage that covers only certain accidents may also be purchased.
  • Specified Disease Coverage - Covers diagnosis and treatment of a specifically named disease or diseases, such as cancer.
  • Other Limited Coverage - May be purchased to cover only dental or vision or other specified care.

Q: What is Disability Income Coverage?
A: Provides for weekly or monthly benefit payments while you are disabled after a covered injury or sickness. The disability payment is usually a set dollar amount not to exceed a certain percentage of your income. These policies usually expire when you become eligible for Medicare.

Q: What is Long-Term Care Insurance?
A: This policy usually pays for skilled, intermediate and custodial care in a nursiing home, and also for care in other settings, such as the home, adult day care center or assisted living facility. The policy usually pays a fixed amount per day while a person is receiving care.

Q: What is Medicare Supplemental Coverage?
A: The federal Medicare program pays most medical expenses for people 65 or older, or for individuals under 65 receiving Social Security disability benefits. However, Medicare does not pay all expenses. As a result, you may want to buy a Medicare Supplement policy that helps pay for certain expenses, including deductibles not covered by Medicare.