MISSION, KS--(Marketwire - Jan 3, 2013) - (Family Features) Millions of working Americans are still without health insurance, and many more worry about whether they'll be able to afford their existing coverage due to rising health costs.
"With the rising cost of care, individuals want more affordable options when it comes to health insurance," says Scott Krienke, senior vice president, marketing and product lines at Assurant Health. "Consumers want coverage tailored to their budget and how they manage their health. Before choosing a health insurance plan, it's important to understand all the options to find the best fit for your needs."
What You Need to Know
Whether you're looking for additional coverage to supplement your employer's plan, or want an individual plan because you're self-employed or uninsured, here are a few tips to get you started.
Under the Affordable Care Act, major medical plans now cover 100 percent of many preventive services. Many people are familiar with major medical insurance, which can be offered by employers and which is usually most comprehensive in covering serious illness or injuries. Major medical plans generally offer the broadest protection and protect against large, unexpected medical expenses.
In general, fixed-benefit plans pay a set amount of money when you have a covered medical service, regardless of the actual cost. For example, if the plan pays $50 when you have an X-ray, but it costs $125, after applying the plan payment of $50, you would owe $75.
Unlike a traditional plan that has deductibles, coinsurance and copays, fixed-benefit plans pay a benefit for covered services immediately. Some provide access to network discounts that can significantly decrease the total cost of care. These plans can cover a range of services from everyday office visits, preventive care and prescriptions, to hospitalization and surgery. Check to see if there are pre-existing condition limitations for the first 12 months of coverage.
Fixed-benefit plans can offer significant coverage. For example, hospitalization reimbursement can be as much as $6,000 per day depending on the plan. Some even offer tools to help manage costs, like guaranteed cost estimates for common services and treatments.
Analyzing Your Insurance Needs
How do you decide what type of plan is right for you? It depends on your needs, what's most important to you, and sometimes the tradeoffs you are willing to make to get the coverage you want at an affordable price. Here is information on those types of plans to help in your decision-making:
- Gives you help with everyday, common medical needs that you are more likely to have.
- Helps you pay for immediate expenses that you are most likely to encounter.
- Gives you more control over your monthly medical expenses. You are willing to take the risk that out-of-pocket costs may exceed the amount of the fixed benefit, and that you would be required to pay remaining balances.
Major Medical Plan
- Provides major medical protection and coverage for your unexpected health care expenses.
- Protects your assets and income while you pay for everyday smaller costs.
- Helps you prepare for unexpected medical expenses. You pay premium, deductibles and coinsurance in exchange for knowing your costs are capped.
Identify Supplemental Insurance Plans You May Want to Round Out Your Plan
Once a decision is made to purchase a major medical plan or fixed-benefit product, supplemental plans can be used to fill gaps in coverage and create additional protection. Supplemental insurance, which can be offered through the workplace or sold individually, offers limited coverage for specific health care needs such as in-hospital care, dental checkups or vision.
"Do your homework, and weigh your options -- there are affordable plans that can fit into your budget and give you the coverage you need to help protect yourself and your family," said Tim Knott, senior vice president of strategic markets and product management for Assurant Employee Benefits. "Supplemental insurance provides a wide array of benefits that can help employees cope with out-of-pocket expenses including those associated with serious accidents or illnesses."
Plans may include:
- Dental - Provides benefits for dental checkups and treatment, which can contribute to better overall health. Many plans provide benefits for additional services such as crowns and orthodontia.
- Vision - Generally will cover vision exams and pay a portion of glasses and contact lens expenses. Some also provide network discounts.
- Accident - Provides benefits for medical care necessary due to an accident. Some also provide benefits for death expenses, dismemberment and disability.
- Critical Illness and Cancer - Provides benefits for diagnosis and treatment of specifically named diseases such as cancer, heart disease and stroke. Many provide a lump sum payment upon diagnosis.
- Hospital Indemnity - Provides benefits for a period of continuous in-hospital care. Some provide benefits for certain outpatient services and costs associated with necessary surgery.
Comparing health and supplementary insurance coverage
To do a comparison of costs and coverage with any plans you're considering, it's wise to look at:
- Premiums, which are the amount paid each month for your plan.
- Access to doctors, hospitals and other providers.
- After-hours access and emergency care.
- Out-of-pocket costs.
- Exclusions and limitations.
How to design a custom, affordable health insurance plan that's right for you
- Decide what's most important to you -- paying for everyday health care needs or catastrophic coverage that caps your costs.
- Check to see if a high-deductible plan with lower premiums is right for you. If you choose this option, you may want to look into the benefits of a pre-tax Health Savings Account to cover out-of-pocket costs.
- If you choose a higher deductible plan, you may want to use a portion of the money saved on premiums for supplemental coverage that can help pay your deductible or other expenses if you have a costly accident or critical illness.
- Consider a no-copay plan. Under the Affordable Care Act, major medical plans now cover 100 percent of many preventive services, so copays may not be worth the additional cost.
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