Your Guide to Buying the Right Type of Health Insurance

When it comes to buying just the right health insurance for you, it’s complicated. There is no one size fits all and the definition of just the right policy depends on your individual needs. Are you the type who needs constant care, or will you be using your insurance sparsely at best? When choosing the right insurance policy for you, it matters. In this article, we’ll go over all the different types of health insurance policies, public and private,as well as what they cover. Purchasing just the right health insurance policy for you depends on knowing exactly what you need, and what’s available, at what cost.

What Type of Health Insurance Do You Need?

Just what type of health insurance do you need? Meaning, what are you going to use it for? Are you expecting to use your coverage for major procedures like cancer treatments, or are you anticipating just the once-a-year visit to your doctor for a checkup? When choosing the right health insurance policy for you, it matters.

What Health Insurance Policies Cover

Health insurance policies generally cover most immediate and some preventative care, medical services and hospitalization.

Medical services

1. Doctor’s visits - Without insurance, a visit to the doctor can cost anywhere from $250 to $500. With insurance, the cost is reduced to anywhere between $35 and $0, using just your copay. (This applies to both your primary care physician and seeing an outside specialist.)
2. Prescription medication - Without insurance, prescription medications can sometimes be in the thousands of dollars. With insurance, the costs are reduced to a simple copay of anywhere from $35 to $0.
3. Emergency care - A trip to the emergency room can cost upwards of a thousand dollars if you’re not insured. Most health insurance plans cover emergency room visits, charging a copay ranging anywhere from $50 to $120.
4. Urgent care - Trips to urgent care facilities are covered in most insurance policies, typically requiring a copay anywhere from $35 to $0.
5. Outpatient Services - Includes diagnostic services, labs and imaging including x-rays, ultrasounds and diagnostic radiology like CT Scans and MRIs. Outpatient services are covered under your health insurance copay ranging anywhere from $100 to $0. *Radiation therapy may require coinsurance.
6. Additional outpatient services - These include mental health services, physical therapy and visits to a skilled nursing facility. These fall under the copay category.
7. Ambulance services - Without health insurance, a ride in an ambulance can cost you thousands of dollars. With health insurance, ambulance services are covered by your copay running anywhere from $250 to $0. Air ambulances typically require additional coinsurance.
8. Dental services - Depending on your policy, dental services and procedures may be covered. This ranges anywhere from oral exams and cleanings to fillings and simple extractions. These are typically covered by a copay.
9. Hearing services - Routine hearing exams are covered with a copay and usually are free. Hearing aids are covered with higher copays ranging anywhere from $300 to $600.
10. Vision services - Typical vision coverage includes free routine eye exams, diabetes and glaucoma screenings. A stipend is allotted toward eyeglasses and contacts once per year.

Additional benefits often include dialysis, podiatry services and home health care. These are covered by copays and coinsurance.

Many insurance policies also cover preventative care such as:

• Routine physical exams
• Tobacco usage counseling
• Vaccines
• Glaucoma testing
• Annual wellness visit
• Screenings for:
• Breast cancer
• Diabetes
• HIV
• Hepatitis C
• Lung cancer
• Obesity
• Depression
• Cardiovascular
• Prostate cancer

Hospitalization and Seriousness Illness

Health insurance covers major medical issues like hospitalization and serious illness. If you don’t have insurance, you could spend as much as $2,000 per day staying in the hospital (almost $4,000 per day in California). Private health insurance plans require you to pay a deductible as well as coinsurance for any hospital stay. While you’re in the hospital, all services and procedures related to your illness are covered, once you’ve met your deductible.

If you have Medicare, you have Part A. With Medicare Part A, hospitalization, no premiums are required. There is a deductible, however, of $1,556. You can cover this with a Medicare supplement or by signing up for a Medicare Advantage Plan. Medicare Part A also covers skilled nursing and rehabilitation centers, as well as long-term hospitalization. For long-term care, your deductible pays for your 1st 60 days. Days 61 and on require you to pay coinsurance. This is why it’s a good idea to have supplemental or a Medicare Advantage Plan to cover these costs.

Health insurance also pays for cancer and other types of long-term treatments that can run into the hundreds of thousands of dollars. Private health insurance like an HMO or a Medicare Advantage Plan pays for as much as !00% of cancer treatments. While you may have to pay a copay whenever you see your oncologist, the treatments themselves are typically covered, including medications and services like MRIs, CT scans and ultrasounds. Paying for cancer treatments without health insurance is simply not doable for most people.

Types of Health Insurance Policies

You should also understand the different health insurance policies available to you.

Private Health Insurance

Private health insurance breaks down into 4 main categories:

1. PPO (Preferred Provider Organization) - PPOs are the best health insurance vehicles when it comes to flexibility and freedom of choice. With a PPO, you choose your own doctor, in-network or not. Be aware, however, that this flexibility comes with a cost. PPO plans are the most expensive.
2. HMO (Health Maintenance Organization) - HMOs, while still delivering good quality of care, are more affordable than PPOs. The only caveat: HMO policyholders must stay in-network. Cost savings comes from the insurer negotiating deals with certain providers, then passing that savings onto you.
3. POS (Point-of-Service Plan) - A POS is a managed healthcare plan that’s sort of a hybrid between an HMO and a PPO. A POS is much like an HMO in that there is a network of providers. What makes a POS different from an HMO is that it will pay for services outside the network if a referral gets made by their primary care physician.
4. EPO (Exclusive Provider Organization) - EPOs offer a local network of providers for the policyholder to choose from. EPO plans are best for healthy people who don’t use their health insurance much, but want it there just in case. EPOs offer higher deductibles and therefore more affordable premiums.

Public Health Insurance

Public health insurance includes Medicare and Medicaid, among other federal, state and local types. The main types of public health insurance include:

• Medicare
• Medicaid
• CHIP (The Children’s Health Insurance Program)
• VA (Veterans Administration)
• CHAMP-VA
• IHS (Indian Health Service)

The most popular are Medicare and Medicaid. Medicare, for those people 65 or older (or the long-term disabled) charges no premiums for hospitalization (Part A), and just $170 per month for medical services (Part B). Medicare also offers a prescription drug plan (Part D), and can be wrapped up into a Medicare Advantage Plan for further savings. Medicaid is free for those who qualify, and administered by the states. 

Employment-Based Insurance vs. the Marketplace

The real question here is: is it more affordable to get insurance through your employer or the Marketplace? In most instances, because you're in a group policy with others, your employer-based health insurance is cheaper. As well, most employers contribute toward your monthly premiums, although they don’t pay the whole thing.

When it comes to Marketplace insurance, you’re not going to get cheap rates unless you’re economically challenged. This means having little to no money and qualifying for healthcare subsidies. Without someone else helping to pitch in for your premiums, it’s hard for Marketplace insurance to be as affordable as with your employer.

Compare Health Insurance

Buying the right health insurance policy means doing your due diligence. This means knowing exactly what you need, and the best place to get it. Knowledge is king, and knowing what you need to be covered and what you do not means everything when choosing the right health insurance policy for you. Let the health insurance experts at Benzinga guide you to finding the perfect insurance coverage for you.

Frequently Asked Questions