Medical Insurance Coverage

When seeking medical insurance coverage, you have to look at a number of items to compare policies that are the same price or close in price. The first is the specific type of insurance coverage to choose. Some policies, such as managed care plans are quite different from the traditional plans.

Traditional plans have a deductible, co-insurance and a maximum out of pocket amount. Some cover specific amounts stated in the policy for each type of procedure. When selecting from various traditional plans, look for one that has the most liberal wording. For instance, if the plan only pays for 10 doctors’ visits a year; you probably don’t want it, no matter how inexpensive it is.

Secondly, look at the amount of the deductible on the medical coverage. The deductible is the money you pay out of your pocket before the insurance company pays anything. It makes sense that the higher the amount of the deductible, the less the premium. However, it also means that you pay more out of your pocket.

After the premium is the amount of co-pay for the medical coverage. The co-pay is the percentage of the bill that you pay with the insurance company paying the balance. Medical insurance coverage with an 80/20 provision means that after you pay the deductible, to a specific point called the maximum out of pocket amount, you pay 20 percent of the bill and the insurance company pays 80 percent.

One newer type of traditional plan is high deductible medical insurance coverage with a health savings account, HSA. You can put any amount you wish in the health savings account, up to a maximum allotted amount based on your deductible. The savings grows tax free and remains that way as long as you use it for medical purposes. This includes items not normally covered by health insurance such as eyeglasses and dental. If you don’t use the funds that year, they roll into the next. They are yours to keep and pass on to your heirs if you don’t use the funds before you pass.

Managed care plans have a co-pay and some may have deductibles, co-insurance and a maximum out of pocket amount in addition to the co-pay. The co-pay for the medical insurance coverage is a small amount you pay each time you visit a doctor or use the services of a health care provider.

Managed care plans also have provisions that either require you to use the services of the preferred providers or the insurance company doesn’t pay anything or increases the amount of the co-pay, co-insurance or out of pocket maximum. HMOs, the strictest form of managed care medical insurance coverage, pays nothing while the PPOs and POS medical insurance coverage adjusts the amount they pay.

When you select a managed care plan, you need to examine the preferred providers on the list carefully. Sometimes plans don’t have preferred providers that are within a reasonable distance to your home. In this case, the medical insurance coverage is almost useless.

Choose your plan wisely taking into consideration co-pays, deductibles and maximum out of pocket. Not every plan suits everyone’s needs. Find the one that works best for your specific situation, and then compare rates to find the best buy.