A health insurance policy is a legal contract that helps individuals and families manage medical expenses and covers financial losses in specific situations associated with healthcare services.
This healthcare protection offers secure claim amounts, high unexpected medical care costs, and more economic stability.
Types of Health Insurance
The health insurance policy is categorized based on different conditions, and the US government also implements specific health insurance plans, such as private and public health insurance plans.
Private Health Insurance: This plan refers to a type of health insurance policy provided by non-governmental entities, including private companies, non-profit organizations, or cooperatives. The two private health insurance plans are described:
- Employer-Sponsored Insurance: Health insurance is provided by the employer and shares the cost of premiums with employees.
- Individual Market: Individuals purchase health insurance directly from insurance companies or the Health Insurance Marketplace.
Public Health Insurance: This plan refers to a type of health coverage provided by government entities with different medical care programs to younger people with disabilities and non-paid medical help. The three public health insurance plans are described:
- Medicare: A program that offers medical help for people aged 65 and older and some younger Americans with disabilities.
- Medicaid: Provides health coverage for low-income individuals and families.
- Children’s Health Insurance Program (CHIP): Provides health coverage to low-income children who do not qualify for Medicaid.
Types of Plans
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Exclusive Provider Organization (EPO)
- Point of Service (POS)
Requirements
There are the following requirements for obtaining United States health insurance, depending on the sources of coverage and checking the detailed information on health insurance:
- Appropriate Information: The candidate provides accurate personal, income, and household information.
- Necessary Documentation: Attach the necessary documentation of citizenship or lawful presence, income, and other paperwork.
- Timely Enrollment: Enroll before the decided periods and deadlines.
Eligibility Requirements:
- Individual and Family Plans: Permanent US citizens enroll in the annual Open Enrollment Period (OEP) and qualify for certain life events, e.g., marriage, birth of a child, and loss of other coverage.
- Employer-Sponsored Insurance (ESI): A full-time employee working 30 or more hours per week offers coverage to part-time employees, dependents, and domestic partners.
- Medicaid: Income, household size, disability, pregnancy, and other factors. Some groups, like children, pregnant women, elderly, and disabled individuals, may have different eligibility criteria.
- Medicare: Age 65 or older, individuals with certain disabilities, and End-Stage Renal Disease (ESRD).
Essential Health Benefits
A health insurance policy covers a set of essential health benefits, including the following features:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Selection Process
Select the best health insurance policy that involves accessing your healthcare needs and financial situation and understanding the different plan options available. There are instructional step guides:
- Access Healthcare Needs: Consider the best healthcare policy, check with doctors and specialists, make a list of medical prescriptions, and get help with planned surgeries or treatments.
- Different Plan Types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Point of Service (POS), and High Deductible Health Plan (HDHP).
- Compare Costs: Compare the monthly payments, out-of-pocket, fixed fees for services, percentage of costs, and 100% of costs.
- Check the healthcare network: Preferred doctors, hospitals, and specialists; and consider the location and availability of in-network providers.
- Evaluate and Check Benefits: Covers essential health benefits such as preventive services, emergency care, hospitalization, maternity care, mental health services, and prescription drugs.
- Financial Assistance: Available for individuals and families with incomes between 100% and 400% of the federal poverty level.