USA Health Insurance Guide

In the US, if you do not have health insurance coverage (medical insurance), you have to pay for health care out of your own finances at the time of service. This can run into many thousands of dollars for serious illnesses. You buy health insurance for the same reason you buy other kinds of insurance: to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very expensive.

You cannot predict what your medical bills will be. In a good year, your costs may be low. But
if you become ill, your bills could be very high. If you have health insurance, many of your costs
are covered by a third-party payer, not by you. A third-party payer can be an insurance company or, in some cases, it can be your employer.

Many people in the United States are enrolled in some sort of managed care health insurance plan. This is an organized way of both providing services and paying for them. Different types of
managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans and fee-for-service plans.

Individuals enrolled in health care plans pay a monthly or quarterly fee for health insurance coverage as insurance for the time when they will need medical attention. At the time when a
service is provided, the health insurance organization pays part or all of the fee, minimizing the amount you have to pay at the time you receive the service.

The information presented here will help you choose a health insurance plan that is right for you.
If you are married or single, have children or no children, this information will help you to find out how to choose a health insurance plan that best meets your needs and your financial
circumstances.

The two main ways that people obtain health insurance coverage are by paying into a group health insurance plan or buying an individual health insurance plan.

Group Health Insurance Plans and Coverage
Most Americans get health insurance coverage through their jobs or are covered because a family member has health insurance at work. This is called group health insurance. Group health
insurance plans are generally the least expensive kind because, in many cases, the employer pays part or all of the health care costs.

Some employers offer only one group health insurance plan. Some offer a choice of group health
care plans, such as:

• Fee-for-Service Health Plans
• HMO: Health Maintenance Organizations
• POS: Point-of-Service Plans
• PPO: Preferred Provider Organizations

Employers with 25 or more workers are required by Federal law to offer employees the chance to enroll in an HMO.

What happens if you or your family member leaves the job? You will lose your employer-
supported group health insurance coverage. It may be possible to keep the same health insurance policy, but you will have to pay for it yourself. This will certainly cost you more than group health insurance coverage for the same, or less, protection. A Federal law makes it possible for most
people to continue their group health insurance coverage for a period of time. Called COBRA (for
the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if you work
for a business of 20 or more employees and leave your job or are laid off, you can continue to
receive health insurance coverage for at least 18 months. You will be charged a higher premium
than when you were working.

You also will be able to receive health insurance under COBRA if your spouse was covered but
now you are widowed or divorced. If you were covered under your parents' group health
insurance plan while you were in school, you can also continue in the plan for up to 18 months
under COBRA until you find a job that offers you your own health insurance.

Not all employers offer group health insurance plans. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer group health insurance, you might be able to obtain group health insurance coverage through membership in a labor union, professional association, club, or other organization.

Individual Health Insurance Plans and Coverage
If your employer does not offer group health insurance coverage, or if the group health insurance offered is very limited, you can buy an individual health insurance policy. You can purchase individual health insurance plans with fee-for-service, HMO, POS, or PPO protection.However, you should compare individual health insurance plans carefully because individual health insurance coverage and costs vary from provider to provider. Individual health insurance plans may not
offer benefits as broad as those in group health insurance plans.

If you purchase a non-cancelable individual health insurance policy (also called a guaranteed renewable policy), then you will receive individual health insurance under that policy as long as
you keep paying the monthly health insurance premium. The insurance company can raise the
cost, but cannot cancel your coverage. Many health insurance companies now offer a
conditionally renewable policy. This means that the health insurance company can cancel all
policies like yours, but not only yours. This protects you from being singled out. But it does not protect you from losing health insurance coverage.

Some tips when shopping individual health insurance plans and coverage:

• Shop carefully. Individual health insurance policies differ widely in coverage and costs. Contact different health insurance companies, or ask your health insurance agent to show
  you policies from several health insurers so you can compare them.
  
  
• Make sure the individual health insurance policy protects you from large medical costs.
  Read and understand the health insurance policy. Make sure it provides the kind of health insurance coverage that is right for you. You do not want unpleasant surprises when you
  are sick or in the hospital.
  
  
• Check to see that the health insurance policy states: the date that the health insurance
  policy will begin paying (some have a waiting period before health coverage begins), and
  what is covered or excluded from coverage.
  
  
• Make sure there is a "free look" clause. Most health insurance companies give you at least
  10 days to look over your health insurance policy after you receive it. If you decide it is
  not for you, you can return it and have your health insurance premium refunded.
  
  
• Beware of single disease health insurance policies. There are some health insurance polices that offer protection for only one disease, such as cancer. If you already have health
  insurance coverage, your regular health insurance plan probably already provides all the coverage you need. Check to see what protection you have before buying any more health insurance.

Before you buy any health insurance policy, make sure you know what it will pay for... and what it will not. To find out about individual health insurance plans, you can call health insurance companies, HMOs, and PPOs in your community, or speak to the agent who handles your car or house insurance. You can also find and compare plans online.

Information taken from Foreignborn.com

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