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Health Insurance Information
Good Decisions Today for a Healthy Tomorrow.
Accidents, injuries and other conditions may affect even the most health-conscious people and lacking adequate coverage that provides access to preventive care and medical services could have catastrophic consequences. Health insurance plays a critical role in helping millions of people maintain their health and wellness.
How Does Health Insurance Work?
Like many types of insurance, health insurance acts as a contract between a policyholder and their insurance company. By paying a regular premium (e.g., monthly or annually), insureds can retain access to financial assistance that may help limit out-of-pocket health care costs. Health insurance policies typically include the following components:
- Premiums are the amount paid on a regular basis to maintain coverage.
- Deductibles are an out-of-pocket minimum the policyholder must pay before their insurance kicks in.
- Copayments are flat fees paid out of pocket for specific services.
- Coinsurance establishes a percentage of total costs that policyholders must contribute for care.
- Out-of-pocket maximums limit the amount a policyholder will pay out of pocket for health care in a single plan year, after which all covered costs will be paid by insurance.
What Are the Different Types of Health Insurance Plans Available?
Health insurance plans may come in many forms, and each has its advantages. Commonly available policies may include the following:
- Health maintenance organization (HMO)—These plans require policyholders to choose a primary care provider who will manage overall care and handle referrals to specialists. HMOs generally cover health care within a specified network, and policyholders are required to pay out of pocket for other services.
- Preferred provider organization (PPO)—Under a PPO, policyholders may need to pay higher premiums and deductibles than if they had an HMO. In exchange, they typically have greater flexibility when selecting health care providers, particularly for out-of-network services.
- Point of service (POS)—These policies act as a hybrid between HMOs and PPOs by having policyholders select a primary physician who coordinates general care while potentially making out-of-network services readily available.
- Exclusive provider organization (EPO)—People who have EPOs may be limited to in-network services if they want them to be covered but are generally not required to select a primary care provider or get referrals to see specialists.
- High deductible health plan (HDHP)—Under an HDHP, policyholders may be able to save on their premiums; however, out-of-pocket costs for services are typically higher. It may be advantageous to combine HDHPs with a health savings account, which can allow deductibles and copays to be tax-free.
What Factors Influence Health Insurance Costs?
Given the many types of plans and high levels of customization available to policyholders, the cost of health insurance can vary significantly. The following factors may contribute to determining a person’s rates:
- Plan type
- Coverage details (e.g., deductibles and policy limits)
- Age and number of insureds
- Tobacco use
Get the Right Coverage
Gerhart, Hartman & Ritner Ltd. has a history of service dating back to 1910. We will draw on our extensive experience to ensure you understand your health insurance options and secure suitable coverage. Contact us today to get started.