Medical Insurance

Many people in the United States take medical insurance for granted – until they are forced to find and buy medical insurance on their own.

Shopping for medical insurance can be a confusing, time consuming and often daunting task. Many people find the medical health insurance purchasing process so difficult, they simply give up and live without any.

Going without medical insurance is unwise and can put you at great physical and financial risk.

So what is the best way to get through the medial insurance purchasing process?

We suggest the following:

  • Get Educated
  • Get Medical Insurance Quotes
  • Meet a Medical Insurance Agent
  • Get a copy of the benefits
  • Gain Knowledge and ask questions
  • Purchase Medical Insurance

Once you have armed yourself with the knowledge you need, you can purchase the plan that best suites your needs. I am always happy to help with any part of the process.

Today, more and more small employer’s are forced to cut or discontinue medical coverage, due to rising premiums, which make it so important to have as many options available to you as possible. Getting educated on the various types of coverage’s is strategically important to position yourself for the future.

HMO’s or Health Maintenance Organizations may provide more benefits at a lower cost. HMO’s offer a wide range of coverage focusing on prevention but may be more restrictive in usage. For example, with an HMO, an insured chooses a primary care physician (pcp) and the physician acts as the director for your health care needs.

If you need to see a specialist, the primary care physician will usually write a referral for you and must be presented at time of care. It is very important that you are sure to get a written referral, if required, or coverage may be restricted. Some carriers may allow you to self refer as long as you stay in the HMO list of providers, while others require a referral to see any specialist.

In short, for some people the HMO’s work perfectly, especially if you don’t mind seeing your primary care physician for a referral if a specialist is required. The HMO will usually cost less in premium and offer a higher level of coverage. For other’s, paying a higher premium to have more freedom and control offer’s peace of mind knowing that there may be more choices available when it comes to your health care.

PPO’s or Participating Provider Organizations gives you freedom of choice, flexibility and a broad range of benefit options. With the PPO plan:

  • There is no need to select a primary care physician; you can choose a doctor whenever you need care.
  • You do not need a referral to see a specialist or to get another opinion about a medical condition.
  • The choice of doctors and hospitals is always yours.

With the PPO plan, you have access to a large network of contracting doctors and hospitals.

  • The network may also include thousands of contracting hospitals across the country.

With the PPO plan, benefits may include coverage for:

  • Doctor office visits
  • Inpatient hospital services
  • Outpatient hospital services
  • Maternity care
  • Hospital emergency medical and accident treatment
  • Breast and cervical cancer screenings
  • Muscle manipulation services
  • Physical, speech and occupational therapies
  • Infertility treatment
  • Mental health and chemical dependency treatment

Coverage may also include preventive care benefits for well-child and adult care, including:

  • Physical exams
  • Diagnostic tests
  • Immunizations

Group plan coverage may vary.

Benefits are paid at the highest level when you receive care from network PPO doctors and hospitals. When you receive care from network PPO doctors and hospitals:

  • There are no claim forms to complete.
  • There are no up-front payments for medical services (except for copayments) and charges for non-covered services.
  • There’s no balance billing—network doctors and hospitals accept negotiated rates
  • You always have the option to receive care outside the network, but your benefits will be paid at a lower level.

Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs.

The US market-based health care system relies heavily on private and not-for-profit health insurance, which is the primary source of coverage for most Americans.

According to the United States Census Bureau, more than 80% of Americans have health insurance; some 60% obtain it through an employer, while about 10% purchase it directly. Various government agencies provide coverage to about 25% of Americans; however there are still many American’s left without coverage due to many different factors, the main two being cost and insurability.

Public programs provide the primary source of coverage for most seniors and for low-income children and families who meet certain eligibility requirements.

Get a quote or apply online