Checkup on US Health Insurance Choices
Today, there are more types of health insurance,
and more choices, than ever before. The information presented here
will help you choose a plan that is right for you. You may be buying
health insurance for the first time, or you may already have health
insurance but want to consider changing plans. Married or single,
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 pocketbook. Definitions of the health insurance terms used
are included in the section called
Understanding Health Insurance Terms.
Thinking About Health Insurance Choices
Which of these statements best describes your thoughts
on health insurance?
"I get health insurance through my job.
I have the coverage I need... I think"
Many employers offer a choice of plans. The
information provided will help you figure out the plan that's best
"I know I need health insurance, but I'm
not sure how to get the best protection at the lowest cost."
You're not alone. Many people have questions about
how to select a health insurance plan. The information provided
will help you find some answers.
"I can't afford health insurance right now. I
have too many bills to pay and other things I need to buy."
Health insurance is one of your most important needs.
Without it, one serious illness or accident could wipe you out financially.
The information provided will help you decide which is the best
plan you can afford.
Why Do You Need Health Insurance?
Today, health care costs are high, and getting higher.
Who will pay your bills if you have a serious accident or a major
illness? 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 can't 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
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.
Where Do People Get Health Insurance Coverage?
Most Americans get health insurance through their
jobs or are covered because a family member has insurance at work.
This is called group insurance. Group insurance is generally the
least expensive kind. In many cases, the employer pays part or all
of the cost.
Some employers offer only one health insurance
plan. Some offer a choice of plans: a fee-for-service plan, a health
maintenance organization (HMO), or a preferred provider organization
(PPO), for example. Explanations of fee-for-service plans, HMOs,
and PPOs are provided in the section called
Types of Insurance.
What happens if you or your family member leaves
the job? You will lose your employer-supported group coverage. It
may be possible to keep the same policy, but you will have to pay
for it yourself. This will certainly cost you more than group coverage
for the same, or less, protection.
A Federal law makes it possible for most people to
continue their group health 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 get health coverage for at least 18 months. You will be charged
a higher premium than when you were working.
You also will be able to get insurance under COBRA
if your spouse was covered but now you are widowed or divorced.
If you were covered under your parents' group plan while you were
in school, you also can continue in the plan for up to 18 months
under COBRA until you find a job that offers you your own health
Not all employers offer health insurance. 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
health insurance, you might be able to get group insurance through
membership in a labor union, professional association, club, or
other organization. Many organizations offer health insurance plans
If your employer does not offer group insurance,
or if the insurance offered is very limited, you can buy an individual
policy. You can get fee-for-service, HMO, or PPO protection. But
you should compare your options and shop carefully because coverage
and costs vary from company to company. Individual plans may not
offer benefits as broad as those in group plans.
If you get a noncancellable policy (also called a
guaranteed renewable policy), then you will receive individual insurance
under that policy as long as you keep paying the monthly premium.
The insurance company can raise the cost, but cannot cancel your
coverage. Many companies now offer a conditionally renewable policy.
This means that the insurance company can cancel all policies like
yours, not just yours. This protects you from being singled out.
But it doesn't protect you from losing coverage.
Before you buy any health insurance policy, make
sure you know what it will pay for...and what it won't. To find
out about individual health insurance plans, you can call insurance
companies, HMOs, and PPOs in your community, or speak to the agent
who handles your car or house insurance.
Tips when shopping for individual insurance:
- Shop carefully. Policies differ widely
in coverage and cost. Contact different insurance companies,
or ask your agent to show you policies from several insurers
so you can compare them.
- Make sure the policy protects you from
large medical costs.
- Read and understand the policy. Make sure
it provides the kind of coverage that's right for you. You don't
want unpleasant surprises when you're sick or in the hospital.
- Check to see that the policy states: the
date that the policy will begin paying (some have a waiting
period before coverage begins), and what is covered or excluded
- Make sure there is a "free look" clause.
Most companies give you at least 10 days to look over your policy
after you receive it. If you decide it is not for you, you can
return it and have your premium refunded.
- Beware of single disease insurance policies.
There are some polices that offer protection for only one disease,
such as cancer. If you already have health insurance, your regular
plan probably already provides all the coverage you need. Check
to see what protection you have before buying any more insurance.
What Are Your Choices?
There are many different types of health insurance.
Each has pros and cons. There is no one "best" plan. The plan that's
right for a single person may not be best for a family with small
children. And a plan that works for one family may not be right
For example, if your family includes just two adults,
it may be less expensive for each of you to have individual coverage
than for just one of you to have a family plan. If you have children,
or if you might have children soon, you need a family plan. Because
your situation may change, review your health insurance regularly
to make sure you have the protection you need.
Choosing a health insurance plan is like making any
other major purchase: You choose the plan that meets both your needs
and your budget. For most people, this means deciding which plan
is worth the cost. For example, plans that allow you the most choices
in doctors and hospitals also tend to cost more than plans that
limit choices. Plans that help to manage the care you receive usually
cost you less, but you give up some freedom of choice.
Cost isn't the only thing to consider when buying
health insurance. You also need to consider what benefits are covered.
You need to compare plans carefully for both cost and coverage.
Although there are many names for health insurance
plans, the information here groups them as three main types:
- Fee-For-Service (or Traditional Health
- Health Maintenance Organizations (or HMOs).
- Preferred Provider Organizations (or PPOs).
Which Type Is Right for You?
For each group, choose the statement 1 or 2 that
best describes how you feel:
- Having complete freedom to choose doctors
and hospitals is the most important thing to me in a health
plan, even if it costs more.
- Holding down my costs is the most important
thing to me, even if it means limiting some of my choices.
- I travel a lot or have children that live
away from me and we may need to see doctors in other parts of
- I do not travel a lot and almost all care
for my family will be needed in our local area.
- I don't mind a health insurance plan that
includes filling out forms or keeping receipts and sending them
in for payment.
- I prefer not to fill out forms or keep
receipts. I want most of my care covered without a lot of paperwork.
- In addition to my premiums, I am willing
to pay for the cost of routine and preventive care, such as
office visits, checkups, and shots. I also like knowing that
I can get an appointment for these services when I want one.
- I want a health plan that includes routine
and preventive care. I don't mind if I have to wait for these
services to be scheduled for an available appointment with my
- If I need to see a specialist, I probably
will ask my doctor for a recommendation, but I want to decide
whom to go to and when. I don't want to have to see my primary
care doctor each time before I can see a specialist.
- I don't mind if my primary care doctor
must refer me to specialists. If my doctor doesn't think I need
special services, that is fine with me.
If your answers are mostly 1: You want to make your
own health care choices, even if it costs you more and takes more
paperwork. Fee-for-service may be the best plan for you.
If your answers are mostly 2: You are willing to
give up some choices to hold down your medical costs. You also want
help in managing your care. Consider a health maintenance organization.
If your answers are some 1's and some 2's: You might
want to look for a plan such as a preferred provider organization
that combines some of the features of fee-for-service and a health
The differences among fee-for-service plans, HMOs,
and PPOs are not as clear-cut as they once were. Fee-for-service
plans have adopted some activities used by HMOs and PPOs to control
the use of medical services. And HMOs and PPOs are offering more
freedom to choose doctors, the way fee-for-service plans do. By
studying your health insurance options carefully, you will be able
to pick the one that provides you with the coverage you need, no
matter what it is called.
Managed Care: A Way to Control Costs
Managed care influences how much health care you
use. Almost all plans have some sort of managed care program to
help control costs. For example, if you need to go to the hospital,
one form of managed care requires that you receive approval from
your insurance company before you are admitted to make sure that
the hospitalization is needed. If you go to the hospital without
this approval, you may not be covered for the hospital bill.
Types of Insurance
This is the traditional kind of health care policy.
Insurance companies pay fees for the services provided to the insured
people covered by the policy. This type of health insurance offers
the most choices of doctors and hospitals. You can choose any doctor
you wish and change doctors any time. You can go to any hospital
in any part of the country.
With fee-for-service, the insurer only pays for part
of your doctor and hospital bills. This is what you pay:
- A monthly fee, called a premium.
- A certain amount of money each year, known
as the deductible, before the insurance payments begin. In a
typical plan, the deductible might be $250 for each person in
your family, with a family deductible of $500 when at least
two people in the family have reached the individual deductible.
The deductible requirement applies each year of the policy.
Also, not all health expenses you have count toward your deductible.
Only those covered by the policy do. You need to check the insurance
policy to find out which ones are covered.
- After you have paid your deductible amount
for the year, you share the bill with the insurance company.
For example, you might pay 20 percent while the insurer pays
80 percent. Your portion is called coinsurance.
To receive payment for fee-for-service claims, you
may have to fill out forms and send them to your insurer. Sometimes
your doctor's office will do this for you. You also need to keep
receipts for drugs and other medical costs. You are responsible
for keeping track of your medical expenses.
There are limits as to how much an insurance company
will pay for your claim if both you and your spouse file for it
under two different group insurance plans. A coordination of benefit
clause usually limits benefits under two plans to no more than 100
percent of the claim.
Most fee-for-service plans have a "cap," the most
you will have to pay for medical bills in any one year. You reach
the cap when your out-of-pocket expenses (for your deductible and
your coinsurance) total a certain amount. It may be as low as $1,000
or as high as $5,000. Then the insurance company pays the full amount
in excess of the cap for the items your policy says it will cover.
The cap does not include what you pay for your monthly premium.
Some services are limited or not covered at all.
You need to check on preventive health care coverage such as immunizations
and well-child care.
There are two kinds of fee-for-service coverage:
basic and major medical. Basic protection pays toward the costs
of a hospital room and care while you are in the hospital. It covers
some hospital services and supplies, such as x-rays and prescribed
medicine. Basic coverage also pays toward the cost of surgery, whether
it is performed in or out of the hospital, and for some doctor visits.
Major medical insurance takes over where your basic coverage leaves
off. It covers the cost of long, high-cost illnesses or injuries.
Some policies combine basic and major medical coverage
into one plan. This is sometimes called a "comprehensive plan."
Check your policy to make sure you have both kinds of protection.
What Is a "Customary" Fee?
Most insurance plans will pay only what they call
a reasonable and customary fee for a particular service. If your
doctor charges $1,000 for a hernia repair while most doctors in
your area charge only $600, you will be billed for the $400 difference.
This is in addition to the deductible and coinsurance you would
be expected to pay. To avoid this additional cost, ask your doctor
to accept your insurance company's payment as full payment. Or shop
around to find a doctor who will. Otherwise you will have to pay
the rest yourself.
Questions to Ask About Fee-for-Service Insurance
- How much is the monthly premium? What will
your total cost be each year? There are individual rates and
- What does the policy cover? Does it cover
prescription drugs, out-of-hospital care, or home care? Are
there limits on the amount or the number of days the company
will pay for these services? The best plans cover a broad range
- Are you currently being treated for a medical
condition that may not be covered under your new plan? Are there
limitations or a waiting period involved in the coverage?
- What is the deductible? Often, you can
lower your monthly health insurance premium by buying a policy
with a higher yearly deductible amount.
- What is the coinsurance rate? What percent
of your bills for allowable services will you have to pay?
- What is the maximum you would pay out of
pocket per year? How much would it cost you directly before
the insurance company would pay everything else?
- Is there a lifetime maximum cap the insurer
will pay? The cap is an amount after which the insurance company
won't pay anymore. This is important to know if you or someone
in your family has an illness that requires expensive treatments.
Health Maintenance Organizations (HMOs)
Health maintenance organizations are prepaid health
plans. As an HMO member, you pay a monthly premium. In exchange,
the HMO provides comprehensive care for you and your family, including
doctors' visits, hospital stays, emergency care, surgery, lab tests,
x-rays, and therapy.
The HMO arranges for this care either directly in
its own group practice and/or through doctors and other health care
professionals under contract. Usually, your choices of doctors and
hospitals are limited to those that have agreements with the HMO
to provide care. However, exceptions are made in emergencies or
when medically necessary.
There may be a small copayment for each office visit,
such as $5 for a doctor's visit or $25 for hospital emergency room
treatment. Your total medical costs will likely be lower and more
predictable in an HMO than with fee-for-service insurance.
Because HMOs receive a fixed fee for your covered
medical care, it is in their interest to make sure you get basic
health care for problems before they become serious. HMOs typically
provide preventive care, such as office visits, immunizations, well-baby
checkups, mammograms, and physicals. The range of services covered
vary in HMOs, so it is important to compare available plans. Some
services, such as outpatient mental health care, often are provided
only on a limited basis.
Many people like HMOs because they do not require
claim forms for office visits or hospital stays. Instead, members
present a card, like a credit card, at the doctor's office or hospital.
However, in an HMO you may have to wait longer for an appointment
than you would with a fee-for-service plan.
In some HMOs, doctors are salaried and they all have
offices in an HMO building at one or more locations in your community
as part of a prepaid group practice. In others, independent groups
of doctors contract with the HMO to take care of patients. These
are called individual practice associations (IPAs) and they are
made up of private physicians in private offices who agree to care
for HMO members. You select a doctor from a list of participating
physicians that make up the IPA network. If you are thinking of
switching into an IPA-type of HMO, ask your doctor if he or she
participates in the plan.
In almost all HMOs, you either are assigned or you
choose one doctor to serve as your primary care doctor. This doctor
monitors your health and provides most of your medical care, referring
you to specialists and other health care professionals as needed.
You usually cannot see a specialist without a referral from your
primary care doctor who is expected to manage the care you receive.
This is one way that HMOs can limit your choice.
Before choosing an HMO, it is a good idea to talk
to people you know who are enrolled in it. Ask them how they like
the services and care given.
Questions to Ask About an HMO
- Are there many doctors to choose from?
Do you select from a list of contract physicians or from the
available staff of a group practice? Which doctors are accepting
new patients? How hard is it to change doctors if you decide
you want someone else? How are referrals to specialists handled?
- Is it easy to get appointments? How far
in advance must routine visits be scheduled? What arrangements
does the HMO have for handling emergency care?
- Does the HMO offer the services I want?
What preventive services are provided? Are there limits on medical
tests, surgery, mental health care, home care, or other support
offered? What if you need a special service not provided by
- What is the service area of the HMO? Where
are the facilities located in your community that serve HMO
members? How convenient to your home and workplace are the doctors,
hospitals, and emergency care centers that make up the HMO network?
What happens if you or a family member are out of town and need
- What will the HMO plan cost? What is the
yearly total for monthly fees? In addition, are there copayments
for office visits, emergency care, prescribed drugs, or other
services? How much?
Preferred Provider Organizations (PPOs)
The preferred provider organization is a combination
of traditional fee-for-service and an HMO. Like an HMO, there are
a limited number of doctors and hospitals to choose from. When you
use those providers (sometimes called "preferred" providers, other
times called "network" providers), most of your medical bills are
When you go to doctors in the PPO, you present a
card and do not have to fill out forms. Usually there is a small
copayment for each visit. For some services, you may have to pay
a deductible and coinsurance.
As with an HMO, a PPO requires that you choose a
primary care doctor to monitor your health care. Most PPOs cover
preventive care. This usually includes visits to the doctor, well-baby
care, immunizations, and mammograms.
In a PPO, you can use doctors who are not part of
the plan and still receive some coverage. At these times, you will
pay a larger portion of the bill yourself (and also fill out the
claims forms). Some people like this option because even if their
doctor is not a part of the network, it means they don't have to
change doctors to join a PPO.
Questions to Ask About a PPO
- Are there many doctors to choose from?
Who are the doctors in the PPO network? Where are they located?
Which ones are accepting new patients? How are referrals to
- What hospitals are available through the
PPO? Where is the nearest hospital in the PPO network? What
arrangements does the PPO have for handling emergency care?
- What services are covered? What preventive
services are offered? Are there limits on medical tests, out-of-hospital
care, mental health care, prescription drugs, or other services
that are important to you?
- What will the PPO plan cost? How much is
the premium? Is there a per-visit cost for seeing PPO doctors
or other types of copayments for services? What is the difference
in cost between using doctors in the PPO network and those outside
it? What is the deductible and coinsurance rate for care outside
of the PPO? Is there a limit to the maximum you would pay out
Checklist: What's Most Important to You?
Insurance plans vary. Before choosing a plan, decide
what is most important to you. This checklist can help. Put a check
in front of those services that are important to you. Then see how
many of these services are in Policy #1, Policy #2, and Policy #3.
On the checklist, write in the coinsurance or copayment rate, if
there is one, and any limits on service.
Remember that the most important service to be covered
is hospitalization. If you are not covered for hospital care, then
one sickness could cost you thousands of dollars, even hundreds
of thousands of dollars.
Service Policy #1 Policy #2 Policy #3
-Office visits to
-Mental health care
braces and cleaning
eyeglasses and exams
-Home health care
-Nursing home care
-Services you need
that are excluded
Other issues that are
important to you:
-Choice of doctors
-Convenient location of
doctors and hospitals
-Ease of getting
-Waiting period before
Which policy is best for you?
Worksheet: What Is Your Best Buy?
It is difficult to determine exactly what you will
spend a year on health care. You do not know whether you will be
sick 6 months from now and need an operation. Hopefully, you will
Using this worksheet, you can begin to make some
rough estimates. Much will depend on what service you need or want,
how many people are in your family, your age, and other factors.
Do you need to have your eyes tested this year? Will you have a
mammogram or other cancer screening test? Does your child need immunizations?
Look at your medical and insurance records from last
year as a guide to what services you might use this year. Add up
the actual costs to you, including premiums. Estimate what you might
spend on your health care in terms of deductibles, coinsurance and/or
copayments, and services that are not covered.
Compare Policy #1, Policy #2, and Policy #3 to determine
which is the best buy for you.
What is your monthly premium? Policy #1 Policy #2 Policy #3
Multiply by 12 for annual cost:
What is your deductible?
(if there is one)
What is your coinsurance rate
or copayment, if there is one?
(Note if there is a higher rate
for special services, such as
outpatient mental health care.)
Are there any annual limits for
days or services covered and
the amount spent on you?
What is the maximum you will have
to pay out-of-pocket each year?
What is the lifetime limit,
if any,that you will be
Total estimated yearly cost
Now look at the checklist of services that are important
to you. Is your best buy the same policy that gives
you the most services you need?
Other Types of Insurance
Medicare is the Federal health insurance program
for Americans age 65 and older and for certain disabled Americans.
If you are eligible for Social Security or Railroad Retirement benefits
and are age 65, you and your spouse automatically qualify for Medicare.
Medicare has two parts: hospital insurance, known
as Part A, and supplementary medical insurance, known as Part B,
which provides payments for doctors and related services and supplies
ordered by the doctor. If you are eligible for Medicare, Part A
is free, but you must pay a premium for Part B.
Medicare will pay for many of your health care
expenses, but not all of them. In particular, Medicare does not
cover most nursing home care, long-term care services in the
home, or prescription drugs. There are also special rules on
when Medicare pays your bills that apply if you have employer
group health insurance coverage through your own job or of a spouse.
Medicare usually operates on a fee-for-service basis.
HMOs and similar forms of prepaid health care plans are now available
to Medicare enrollees in some locations.
The best source of information on the Medicare program
is the Medicare Handbook. This booklet explains how the
Medicare program works and what your benefits are. To order a free
copy, write to: Health Care Financing Administration, Publications,
N1-26-27, 7500 Security Blvd., Baltimore, MD 21244-1850. You also
can contact your local Social Security office for information.
Some people who are covered by Medicare buy private
insurance, called "Medigap" policies, to pay the medical bills that
Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles;
most pay the coinsurance amount. Some also pay for health services
not covered by Medicare. There are 10 standard plans from which
you can choose. (Some States may have fewer than 10.) If you buy
a Medigap policy, make sure you do not purchase more than one.
You need to shop carefully before deciding on the
best policy to fit your needs. You may get another booklet,
Guide to Health Insurance for People with Medicare, to help
you in making the right choice. To order a free copy, write to:
Health Care Financing Administration, Publications, N1-26-27, 7500
Security Blvd., Baltimore, MD 21244-1850.
Another good source of information on the same topic
is The Consumer's Guide to Medicare Supplement Insurance.
To order a free copy, write to: Health Insurance Association of
America, 555 13th St., N.W., Suite 600 East, Washington, D.C. 20004.
Medicaid provides health care coverage for some low-income
people who cannot afford it. This includes people who are eligible
because they are aged, blind, or disabled or certain people in families
with dependent children. Medicaid is a Federal program that is operated
by the States, and each State decides who is eligible and the scope
of health services offered.
General information on the Medicaid program is given
in the Medicaid Fact Sheet. For a free copy, write to:
Health Care Financing Administration, Publications, N1-26-27, 7500
Security Blvd., Baltimore, MD 21244-1850. For specifics on Medicaid
eligibility and the health services offered, contact your State
Medicaid Program Office.
Disability insurance replaces income you lose if
you have a long-term illness or injury and cannot work. This is
an important type of coverage for working-age people to consider.
Disability insurance does not cover the cost of rehabilitation if
you are injured. Check your major medical insurance to see if it
is covered there.
Some employers offer group disability insurance and
this may be one of the benefits where you work. Or you might be
eligible for some government-sponsored programs that provide disability
benefits. Many different kinds of individual policies are also available.
The Consumer's Guide to Disability Insurance
explains disability insurance and sources of disability income to
help you decide if you need this coverage. It will also help you
compare your choices of policies. For a free copy, write to: Health
Insurance Association of America, 555 13th St., N.W., Suite 600
East, Washington, D.C. 20004.
Hospital Indemnity Insurance
This insurance offers limited coverage. It pays a
fixed amount for each day, up to a maximum number of days. You may
use it for medical or other expenses. Usually, the amount you receive
will be less than the cost of a hospital stay.
Some hospital indemnity policies will pay the specified
daily amount even if you have other health insurance. Others may
coordinate benefits, so that the money you receive does not equal
more than 100 percent of the hospital bill.
Long-term care insurance is designed to cover the
costs of nursing home care, which can be several thousand dollars
each month. Long-term care is usually not covered by health insurance
except in a very limited way. Medicare covers very few long-term
care expenses. There are many plans and they vary in costs and services
covered, each with its own limits.
More detailed information is given in A Shopper's
Guide to Long-Term Care Insurance. Contact your State Insurance
Department or write: National Association of Insurance Commissioners,
120 W. 12th Street, Suite 1100, Kansas City, MO 64105.
Another good source of information is The Consumer's
Guide to Long-Term Care Insurance. For a free copy, write to:
Health Insurance Association of America, 555 13th St., N.W., Suite
600 East, Washington, D.C. 20004.
A Final Word
There's no doubt that choosing among health insurance
plans takes time and effort. Now that you have read this information,
you know what questions to ask so you will be able to carefully
compare various plans and find the one that best fits your needs.
Understanding Health Insurance Terms
Coinsurance: The amount you are required to pay for
medical care in a fee-for-service plan after you have met your deductible.
The coinsurance rate is usually expressed as a percentage. For example,
if the insurance company pays 80 percent of the claim, you pay 20
Coordination of Benefits: A system to eliminate duplication
of benefits when you are covered under more than one group plan.
Benefits under the two plans usually are limited to no more than
100 percent of the claim.
Copayment: Another way of sharing medical costs.
You pay a flat fee every time you receive a medical service (for
example, $5 for every visit to the doctor). The insurance company
pays the rest.
Covered Expenses: Most insurance plans, whether they
are fee-for-service, HMOs, or PPOs, do not pay for all services.
Some may not pay for prescription drugs. Others may not pay for
mental health care. Covered services are those medical procedures
the insurer agrees to pay for. They are listed in the policy.
Deductible: The amount of money you must pay each
year to cover your medical care expenses before your insurance policy
Exclusions: Specific conditions or circumstances
for which the policy will not provide benefits.
HMO (Health Maintenance Organization): Prepaid health
plans. You pay a monthly premium and the HMO covers your doctors'
visits, hospital stays, emergency care, surgery, checkups, lab tests,
x-rays, and therapy. You must use the doctors and hospitals designated
by the HMO.
Managed Care: Ways to manage costs, use, and quality
of the health care system. All HMOs and PPOs, and many fee-for-service
plans, have managed care.
Maximum Out-of-Pocket: The most money you will be
required pay a year for deductibles and coinsurance. It is a stated
dollar amount set by the insurance company, in addition to regular
Noncancellable Policy: A policy that guarantees you
can receive insurance, as long as you pay the premium. It is also
called a guaranteed renewable policy.
PPO (Preferred Provider Organization): A combination
of traditional fee-for-service and an HMO. When you use the doctors
and hospitals that are part of the PPO, you can have a larger part
of your medical bills covered. You can use other doctors, but at
a higher cost.
Preexisting Condition: A health problem that existed
before the date your insurance became effective.
Premium: The amount you or your employer pays in
exchange for insurance coverage.
Primary Care Doctor: Usually your first contact for
health care. This is often a family physician or internist, but
some women use their gynecologist. A primary care doctor monitors
your health and diagnoses and treats minor health problems, and
refers you to specialists if another level of care is needed.
Provider: Any person (doctor, nurse, dentist) or
institution (hospital or clinic) that provides medical care.
Third-Party Payer: Any payer for health care services
other than you. This can be an insurance company, an HMO, a PPO,
or the Federal Government.
Checkup on Health Insurance Choices.
AHCPR Publication No. 93-0018, December 1992. Agency for Health
Care Policy and Research, Rockville, MD. http://www.ahrq.gov/consumer/insuranc.htm
County Resources to Come.
More Zip Code searches for top insurance providers
by county are to follow.