The health insurance system in the United States varies by state and type of plan, but most plans share some basic features. Most provide a fixed monthly payment, called a premium, that covers some or all of the cost of medical care for the insured person and his or her family members. The payments are subject to certain limitations, such as deductibles and copayments. Some plans also include benefits such as hospitalization and prescription drugs. In addition, many individuals who purchase individual health plans are eligible for tax credits to help pay the premium and out-of-pocket costs.
Most employers offer group health insurance to their employees. Those who do not have employer-sponsored coverage can buy individual policies, or they may be able to use a public program such as Medicaid. Individuals who change jobs or lose their employment may be able to keep their health coverage by purchasing a plan on the marketplace or through NY State of Health (a tax credit may be available), or they can get coverage from a small business owner’s group plan, or qualify for a special continuation coverage option under federal law.
When choosing a plan, you should start by assessing the level of coverage you require. Do you need comprehensive coverage that includes hospital stays, or do you simply need basic coverage for doctor’s visits and prescriptions? Many insurers offer a variety of plans that fit different needs, and you should compare them to find the best fit for your situation.
You should also take into account the amount you can afford to spend each year on health care. Most plans have annual maximums on out-of-pocket costs, which can help you limit your exposure. You should also look at the types of providers the plan uses, and whether it is restricted to in-network providers or if you can go outside the network. Some plans, such as an HMO, are limited to in-network providers and do not cover care outside the network unless it is an emergency. Other plans, like PPOs, allow you to go out of network but pay only a percentage of the cost, called coinsurance.
Aetna, which offers a variety of plans, has one of the lowest NAIC complaint indexes among major health insurance companies. Its plans feature low copays for doctor and pharmacy visits, and the company offers eight medical management programs that address issues like depression and asthma.
The most important consideration when shopping for a health insurance plan is to choose the right amount of coverage for your needs. Most people choose a plan that will meet most of their health care needs at a reasonable cost. This will ensure that you are covered for major illnesses and accidents, but it is possible to over-insure, which can be costly. When selecting a policy, be sure to consider any pre-existing conditions you have that might prevent you from getting the coverage you need. The good news is that most health insurance plans now do not exclude pre-existing conditions, and you can buy coverage that will cover them starting from the date of your first application for the policy.