How to Choose the Best Healthcare Coverage for Me and My Family?

President Obama signed into law on March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) that states every American citizen has a right to receive medical coverage. The premiums on medical insurance coverage have increased in retrospective of this law; however, it is a step in national healthcare reform that can provide insight into what medical coverage is best suited to the individual.

Some benefits of the PPACA that can help one in choosing the best healthcare coverage is that it is provided to a person regardless of employment or economic status, it increases the coverage for those with a pre-existing medical condition, increases coverage options, and eliminates the lifetime cap of medical insurance coverage. Before choosing the best healthcare coverage, it is best to understand the types of coverage available. There are seven different healthcare options one can choose from when deciding on the best coverage for yourself and long-term coverage for your family.

PPO

PPO healthcare means Preferred Provider Option. This option has a group of doctors and health care facilities in what is called a network. Those in this network have chosen to provide services to members of the PPO. A member must choose a doctor and medical facility within this network. A person pays a percentage (deductible) of the medical services.

This is a great option for those who already have a physician within this network. Referrals can always be made to specialists outside of the network, and it will be covered. This option gives you the freedom to choose.

HMO

Lots of negativity has spread in the news about HMOs (Health Maintenance Organization), but it is a great option for those on a limited budget. It is basically a one-stop-shop for all your healthcare needs. A HMO bases its foundation on preventive healthcare and well-being. Doctors are mainly available at the same location and/or medical facility.

This is an affordable option for those not only on a limited budget, but for families as well. It is one of the cheapest options in healthcare as it has one set premium, and all the medical visits are covered under this premium. The downside to belonging to an HMO is that it will not cover you if you see someone outside of its facility, unless you are directly referred. It limits your choices.

POS

A POS is a Point of Service coverage option. Although not commonly known by individuals, it is similar to the functioning of a HMO provider. One has the option of choosing a primary care physician within the network, whereas with a regular HMO you have no choice. This is a very restrictive type of coverage as no coverage is given if one sees a medical provider or facility outside of the designated network.

This type of coverage is cheaper than other healthcare options, and is best for single, young people who are healthy and may not need to see a doctor regularly.

Indemnity Plan

This plan offers a person the most freedom. One can choose what doctors and medical facility to be treated at – there are no restrictions. If one wants to see a specialist, no doctor referral is needed. The deductible for the coverage is a percentage of the charge. It does require the annual deductible to be paid upfront in the beginning of the coverage year, so it can be costly.

Dependent Young Adult

In the past, before the PPACA, many young adults were left uncovered by health insurance when they became adults, creating a large gap in the amount not receiving medical insurance.  With the assistance of the PPACA’s health care reform, young adults up to the age of 26 can be covered under their parents’ medical insurance plan.

Regardless if a young adult is in college, employed, or married, he or she can still be a dependent under a parent’s health insurance coverage. A young adult has the option, if employed, to take the employer’s insurance coverage and remain under his or her parent’s coverage, called dual coverage. This is beneficial, as out-of-pocket medical expenses can be decreased. No insurance plan can deny coverage to a young adult under the age of 26. That is the law.

Dependent Aged Parent

There may be situations where health care coverage is needed for a parent. In America, the IRS has set guidelines that allow one to add a parent to his or her health care coverage plan. One must be the primary caregiver of his or her parent for more than half of a calendar year. The parent has to be under the age of 65 and make less than $3650 gross income in a year. In addition, to be considered under the dependent parent health care coverage, a parent must not have any form of medical or dental insurance.

If a parent meets all this criteria and is claimed on taxes as a dependent, health care coverage can be obtained. The child claiming his or her parent as a dependent must have a family medical plan, not an individual plan. Although there are Federal guidelines to claiming a parent as a dependent on health care coverage, not all insurance companies accept this type of coverage.

For those whose parents are over the age of 65, America provides Medicare health insurance coverage. This ensures that there is no lack in medical coverage, especially since many ailments, both physical and mental, can occur as we age. Another option for a child, is to purchase long-term care medical coverage for his or her parents. This coverage can be provided through an employer, or independently and can offset the cost of medical bills not covered by Medicare.

Supplemental Health Coverage

Health insurance covers the basics in medical coverage, but it doesn’t cover everything. This is where supplemental health coverage companies come in. This type of coverage is bought by an individual to supplement a medical plan. The maximum benefit amounts are paid in dollar amounts and not in percentage deductibles or copayments. Benefits are paid directly to the individual, and not to the medical care giver or facility.

This is an affordable alternative to healthcare insurance, and is usually less than the regular insurance coverage premiums. It always offer stable payments with no questions asked. It helps pay for expenses not covered by health insurance, such as mortgages, groceries, and health care deductibles.

Monies received from a supplemental coverage plan do not need to be used for the medical condition. It can be used for loss wages, hospital payments not covered by health insurance, long-term illnesses not covered completely by insurance, pre-existing medical conditions, or for whatever needs one may have due to an illness or injury.

In choosing one of these healthcare types of coverage, there are several factors that one might have to consider before making a decision:

• Your yearly salary – How much of the premium can one afford will determine the medical coverage that is chosen.
• Your monthly budget in relation to making co-payments or percentage deductibles – Many times, it is easier for one to pay a set co-payment than a percentage deductible, as one never knows for certain how much that deductible will be.
• Pre-existing conditions and medical treatments needed – In the past, many people with pre-existing conditions were denied medical coverage or left with long waiting periods. People in this situation were often left without medical coverage. Under the PPACA, this is no longer applicable. It will completely end the exclusion of people with pre-existing illnesses from receiving medical coverage in 2014. There will be no delays or waiting periods in receiving medical treatment. Whether it is an HMO or PPO, all medical insurance companies must cover all its members.
• Your age and health – If you are young and healthy, you can choose plans with lower premiums and higher deductibles, because you most likely will not be seeking medical care as often as one who is older or who has children.
• Medication dependency – If you or your covered dependents take regular prescribed medications, picking a healthcare coverage plan with low prescription payments is most beneficial.
• Family planning – If you are planning to have a family, choosing a plan that offers well-baby care and good coverage for childhood immunizations with minimal co-payments may be the best option in medical insurance coverage.
• Coverage of natural remedies, such as chiropractic care – Many health insurance companies now offer this option. If this is the type of coverage you want, then you need to be aware if it is covered under your plan.
• Coverage for dependents – This is needed for those with young adult children or older parents.

It is important to review each type of medical plan before making a final decision. Each individual has different needs, and these plans are designed with that in mind. There is always an open enrollment period each year, so if one plan does not fit the needs of the individual or family, another plan can always be chosen.

Byline:  Joe Johnson resides in Minnesota and enjoys sharing his knowledge and experience in health and fitness with others. He is a self-made entrepreneur that operates a popular business to order personal checks. This business offers savings to consumers with discount checks online.