| Health care insurance can be confusing | | | | insurance covers only illness or |
| even for those who have some experience | | | | accidents, and does not pay for |
| with it. For those who are new to it, it | | | | preventive care such as flu shots or |
| can be downright unfathomable. A good | | | | birth control medication or devices. |
| place to begin learning more about the | | | | Depending on your policy, it may or may |
| issues behind health care insurance is | | | | not pay for prescription drugs or |
| with the basics. | | | | psychotherapy. |
| There are, generally, two types of | | | | Managed care can be thought of as the |
| health care insurance: indemnity and | | | | opposite of indemnity care. With a |
| managed care which is often referred to | | | | health maintenance organization (HMO), |
| as HMO. | | | | your deductibles are often smaller than |
| Indemnity health care insurance is also | | | | with other plans. In some cases, there |
| known as "fee-for-service". This type of | | | | may not be any deductibles at all. |
| insurance will offer the most | | | | Co-payments are almost always fixed and |
| flexibility because it allows you to | | | | kept low. Most preventive care, drugs, |
| pick your own doctor, clinics, | | | | and mental health treatments are covered |
| hospitals, etc. The downside is that it | | | | but you should always check on this. |
| will cost a good deal more than the | | | | The downside to managed care health |
| managed types of health care plans. | | | | insurance is that you must choose from |
| These added costs may be reflected in | | | | doctors, hospitals, and other health |
| the premiums that you pay, but they will | | | | care providers who have contracts with |
| certainly be reflected in the out of | | | | your HMO. In other words, you cannot |
| pocket costs that you have to pay when | | | | simply go to whomever you want. Also, |
| you go for care. For many people, the | | | | you are limited to receive only those |
| out of pocket costs can make indemnity | | | | medical services authorized by the plan |
| health insurance a non-option. | | | | that you have. If you use non-authorized |
| In addition to much higher out of pocket | | | | providers or receive non-authorized |
| cost you will also be required to pay an | | | | care, your insurance will not pay any |
| annual deductible, which can range from | | | | portion of the bills. |
| a few hundred dollars to a few thousand | | | | Because many people did not like these |
| dollars. This amount must be paid before | | | | restrictions, managed care has begun to |
| the insurance will even begin to pay. | | | | evolve to include hybrid plans that |
| Once the annual deductible has been paid | | | | blend HMOs with some of the features of |
| into your account, the insurance company | | | | indemnity health care coverage. |
| will then pay a portion of what is owed. | | | | One example is the Point-of-Service |
| You will normally have to make a | | | | plan. If you are under a |
| co-payment of around twenty percent or | | | | point-of-service plan (POS), you can |
| so, and the insurance company will then | | | | keep your overall costs low by using a |
| pay its eighty percent. If the doctor or | | | | network of doctors and hospitals that |
| other health professional charges high | | | | have contracts with your insurer. If you |
| rates to begin with, you may end up | | | | decide to go outside the network that |
| paying a higher rate because the | | | | has been set up for the plan, you will |
| insurance company will normally pay only | | | | have to pay an added deductible as well |
| what it considers to be "usual and | | | | as higher co-payments for the services |
| customary" fees for the service. | | | | rendered. |
| Generally, indemnity health care | | | | |