Health insurance coverage is basically divided into two types: Fee-for-Service and Managed Care.
Fee-for-Service, or traditional health insurance, is based on the medical professional being paid a certain fee for service provided to the patient. In this type of policy, the insured or the health professional presents a claim to the insurance company, and the health care provider is paid by the insurance company. The amount paid will depend on factors such as the amount of deductible paid by the insured before the insurance pays, the co-pay made by the insured, and company limits on the amount to be paid for a specific service or treatment (usually defined as “usual & customary” and based on the company’s database of charges usually charged in a certain region). Many people choose this type of insurance plan because it allows them to use the doctors and medical facilities they prefer.
Managed Care includes several types of plans, such as HMOs (health maintenance organizations), PPOs (preferred provider organizations), and POS (point of service plans). Each of these plans is slightly different, but the common factor is that they provide comprehensive health care services to their members, and they require members to use specific in-network providers or pay a larger fee for using healthcare professionals or facilities that are not part of the specific organization.
There are several other types of specialized health care insurance. You may wish to consider a Medicare Supplement policy if you are over 65 and depend on Medicare as your primary health insurance. You may want to look into special dental or vision insurance coverage if these costs are not addressed by your healthcare insurance. In addition, you may wish to add coverage against certain catastrophic health conditions, such as cancer, with a specialty insurance policy.
Your Schultheis Insurance Agent can help you evaluate your health insurance needs and select the policy that will provide you with the coverage you require.