Health Insurance

Health Insurance, like any other type of insurance, is protection. Depending on the type and comprehensiveness of your coverage, health insurance can pay for a wide variety of medical needs. More than likely, health insurance's biggest benefit occurs when you or a family member needs medical attention.

Health Insurance is usually categorized as Indemnity (fee-for-service) or Managed Care. With either option, there is a basic premium, which is how much you or your employer pay, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by plan.

Indemnity Plans usually offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans. Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed Care Plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care type plan and a broader choice of health care providers if you select an indemnity-type plan.

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Health Insurance Types (Indemnity and Managed Care):

1. Indemnity Plans
   These plans allow you to choose any doctor or hospital when seeking medical care. These plans typically have a deductible which must be met before any benefits are paid. After meeting your deductible, the plan pays a percentage, typically 70% to 90% of incurred charges. The remainder of the bill is the responsibility of the insured.

Managed Care Options include:

1. HMO Plans
   These plans are somewhat more restrictive in nature than other plans but, in some cases, carry significant financial savings to the insured. HMO providers usually agree to substantially reduced charges, and these lower fees can be reflected in lower insurance premiums. There are usually no deductibles, a small co-pay per visit ($5-$10) with all other charges covered. Normally, all covered members select a Primary Care Physician, from a list available in your area, and that doctor is responsible for meeting all your health care needs. If you need to visit a specialist, you must get a referral from your Primary Care Physician.
2. PPO Plans
   These plans usually offer a large list of doctors and hospitals from which you must select in order to receive maximum benefit. These plans typically have a deductible and pay a percentage of the charges. Similar to an HMO plan, Medical care providers generally agree to reduced fees in order to participate in these PPO plans. Because of this reduced fee, these plans tend to be less expensive than Indemnity Plans.
3. Point-of-Service (POS) Plan
   Many HMOs offer an indemnity-type option known as a POS plan. The primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, members can refer themselves outside the plan and still get some coverage. If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have to pay coinsurance.

Other Coverage Types

1. Medicare
   Provides coverage for people who have qualified for Social Security. The majority of people who qualify for Medicare become eligible at age 65. Under some circumstances, extreme disabilities may qualify a person for Medicare before age 65. Medicare provides comprehensive coverage but can have some larger payments than other traditional plans, therefore many Medicare recipients buy relatively inexpensive supplements.
2. Medicaid
   Medicaid covers some low-income people (especially children and pregnant women), and disabled people. Medicaid is a joint Federal-State health insurance program that is run by the States.
   

Options to Consider:

1. Dental Insurance
   Some health insurance plans will include coverage for your teeth. Deductibles and options differ from plan to plan and should be reviewed carefully with your Hill Insurance agent.
2. Eye coverage
   Some employers offer eye care coverage or vision care coverage through a medical benefits plan. There are usually a few options to choose from including eye exams, discounts on glasses, etc.
3. Deductible
   The deductible is the amount of money that you must pay before your health insurance company will pay the balance of your medical bills. Your plan may require an individual or family deductible, but you must meet it with your own money before the insurance company will pay.
4. Co-Insurance
   The amount your health insurance company will pay once the deductible has been met. Percentages vary ranging from as low as 50% to as high as 100%. The most common co-insurance percentage is 80%. Most plans have a maximum out of pocket expense. This means that once you pay a specified amount, say $2,000, the health insurance company will pay a higher percentage.
5. Out of Pocket Maximum
   This term is related to co-insurance and is the maximum amount of money you are expected to pay under your health insurance plan. Once you have met your out of pocket maximum, the insurance company will pay all remaining bills. Plan definitions vary widely so it is very important to verify this coverage with your Hill Insurance agent.
6. Benefit Ceiling
   This is the maximum amount that the health insurance company will pay. Most insurance plans offer a benefit limit of at least $1,000,000.

CONTACT Hill Insurance Agency to find out what coverage best fits your needs. Hill Insurance tailors the coverage to fit your situation.