Much as we’d like to think otherwise, the human body is not invincible. It can fall victim to illness or accident. Most often, it succumbs to the daily wear and tear of life. Obtaining the right type of health insurance for you and your family’s needs should not be an eventuality. Whether you are single, married, still in college or thinking about retiring, you need health insurance now. If you have employer-provided health insurance, or need find yourself preparing to purchase an individual health care plan, here are some things to look for in health insurance.
Co-pays
Co-payments are out-of-pocket expenses paid for by the individual. Co-pays are typically required for any of the following:
1. Doctor Visits
2. Specialty Doctor Visits
3. Prescriptions
4. Emergency Room Visit
5. Immunizations
Many people make their decision about their health insurance based on the price of prescription co-pays alone. Sometimes co-payments are a flat dollar amount; others they are a percentage of the total amount billed to the insurance. Co-pays can be deceptive. For example, those $10 prescription co-pays generally only refer to generic medications. This is not a problem for most of the population. However, if you have a more serious health concern that requires ongoing maintenance, you may find yourself paying more for non-generic brands of antibiotics and other drugs.
Make your decision about health insurance based on more than just co-pays. Be willing to sacrifice more out of pocket expense for co-pays if it means you have fuller coverage in other areas, such as hospital visits.
Hospitalization Coverage
No one wants to be in the hospital. Bad food aside, hospital visits can cost thousands of dollars. The expense increases depending on the type of medical attention you can require. Without health insurance, a procedure such as an appendectomy (removal of the appendix) could cost you tens of thousands of dollars.
I’ve been hospitalized more than once in the past year. Whenever I get the statement in the mail telling me how much my insurance covered, I breathe a sigh of relief. My health insurance covers me 100% for hospitalizations. Without it I would have had to find a way to pay nearly $60,000.
Durable Medical
Durable medical refers to anything you need by way of devices, equipment, etc. to manage your health. Patients with asthma, for example, would be wise to look for a health insurance plan that covers the cost of nebulizers and compressors they need to administer aerosolized medication. Durable medical also refers to home health care treatment, such as would be required for cystic fibrosis patients on home intravenous therapy.
Unfortunately, durable medical does not typically cover eyeglasses or hearing aids. Be sure to obtain additional coverage if those are a need for you or your family.
Making it Work
Health Maintenance Organizations (HMOs) generally offer the biggest bang for your health insurance buck. This is especially true if you have a condition such as cystic fibrosis or multiple sclerosis, each of which requires regular doctor visits. In the past, HMO’s have gotten a bad reputation. If you are covered by an HMO, be sure to familiarize yourself with the company’s “Evidence of Coverage” booklet.
No matter what type of coverage you purchase, it’s important that you familiarize yourself with the policies and procedures of your health insurance plan. Never assume that anything is automatic. To get the most out of your coverage, you need to be diligent to follow up with any paperwork that may be required. Also, don’t be intimidated by your health insurance provider. Ask questions when you don’t understand something about your coverage. Consider them a vital and beneficial part of protecting your health.