Kids and Health Care: How Health Insurance Works Introduction
In Chapter 1, we considered how doctors and hospitals function...and how they expect to be paid for caring for someone who's injured or sick. In the United Sates, the main mechanism for making these payments is health insurance. For adults under age 62, health insurance is a necessity -- the only real option to it is government-run programs for the indigent, which operate under the umbrella program name "Medicaid."
Working-age adults who can't afford health insurance often go without coverage. And, in some cases, that can be a rational decision.
For children, going without coverage doesn't make as much sense.
First, many injuries, illnesses and medical conditions that occur in childhood can affect a person's health for his or her whole life. The high fever associated with as simple an illness as strep throat can cause blindness or deafness. A blow to the head from a fall at a soccer game can trigger epilepsy. Providing quality health care to children can minimize or eliminate these long-term effects.
Second (and as a result), there are more options available for paying for childrens' health care. Various programs -- run by both the private sector and the government -- offer medical coverage or the means for paying for medical coverage for kids. In fact, there are so many of these programs that even health care industry experts usually don't know them all.
When it comes to medical coverage for your child, you usually have a few basic choices: Do you want to join a managed care program like a health maintenance organization (HMO) or a preferred provider organization (PPO)? Or do you want to pay more for an indemnity policy?
There's not much expert consensus about which coverage is the best for families with children. The closest thing to conventional advice is that an HMO or PPO usually has lower premiums and keeps out-of-pocket expenses to a minimum.
However, some parents feel strongly that the limits that managed care put on which doctor you can see or which hospital you can visit are particularly bad for kids, whose conditions are sometimes difficult even to diagnose.
In this chapter, we'll consider how indemnity insurance works for families with children in more detail.
