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Medical Insurance – Premiums, Availability and Benefits

We want to make shopping for affordable, high-quality medical insurance as simple as possible. To help you make an informed decision, we have created a comprehensive guide to understanding medical insurance, its premiums, availability, and benefits.  Below you find information about medical insurance rates, medical insurance quotes and major medical insurance companies.

What Medical Insurance Covers

Medical insurance is a form of insurance purchased by policyholders to help in the event of a medical emergency, doctor visits, prescriptions, other medical expenses, and even long-term care. In short, medical insurance is protection against financial loss due to illnesses or bodily injuries. In the event of a medical need, your insurance policy, or medical insurance contract, guarantees that your insurance company will pay the agreed portion of your medical expenses. Your coverage, or the guaranteed portion of payment made by your insurance company, is determined by age, medical history, employment, family needs, and a variety of other factors. Medical insurance coverage is the amount of insurance, or safety against financial loss, that can be purchased. This defines what medical expenses are eligible for payment.

For example, you schedule your routine dental checkup only to discover you need a root canal as well as a cleaning. If dental expenses are not part of the coverage in your policy, your costs will be significantly higher. Should you have purchased dental coverage, your costs will be significantly lower depending on your policy’s deductible. A deductible is the amount a medical insurance policyholder must pay out-of-pocket before an insurance company will begin payments for any medical expenses.

Medical insurance is a very broad term for any form in which an insurance company guarantees an agreed upon percentage of payment for the purchaser’s medical expenses. As a policyholder or potential purchaser, it is very important to understand the terms and agreed upon policies, coverage, and percentages in your contract. Take the time to speak with a medical insurance agent who will help you better understand your insurance policy. Most medical insurance companies offer free quotes for those seeking a better idea about the amount of coverage available and the cost of their coverage.

Medical Insurance Quotes

A medical insurance quote is an estimate of the coverage and rates available to you based on a variety of factors. Health Insurance Online can help you find a variety of tools to find affordable medical insurance plans and even allow you to compare similar policies side by side. Medical insurance quotes give you the opportunity to find the policy and coverage that is right for you at a price you can afford.

When requesting a medical insurance quote, most companies will give you an instant quote, based of course on the questions you answer. Instant quotes are simply an educated guess on the coverage you might need or want with your answers in mind. They will give you a fairly accurate look at what a policy might cost you at any given medical insurance company. Should you be pleased with the amount of coverage and its rate, take the next step and contact an agent for a more detailed and accurate description.

Here at Health Insurance Online, we offer a variety of ways to find the right medical insurance for you. Simply fill out the above form and have one, if not several, quotes will be available for you. Here are some common questions potential purchasers ask:

• Q: Why do they need to know my age? Will that take away my coverage?
• A: No, insurance companies will not “take away” your coverage, but adjust it based on the needs of the average person at that age. For example, the needs of a twenty-one year old male will be very different than a sixty-five year old female. Coverage designed for young male would be very unfit for an older female policyholder. Therefore, it is vital for medical insurance companies to be aware of your age before they can give you an accurate quote.
• Q: What if my employer already offers medical insurance?
• A: Not all employers offer medical insurance. Congratulations if your employer does! However, most group plans do not medical costs associated with eye, dental, or other supplementary needs. Perhaps your family has a history of cancer, diabetes, or other illnesses; medical insurance companies can help you protect yourself in the event that you or a family member may develop an illness. Based on your group plan, medical insurance companies are able to offer you additional, supplementary coverage in an area that you or a loved one may be susceptible to.

Affordable Plans and Medical Insurance Rates

The affordability of your plan is based on many contributing factors. For a medical insurance company to generate enough funds to meet policyholder needs and company expenses, insurers must be able to balance potential risks with the potential costs of coverage. The process of determining coverage is most often conducted by a process called “medical underwriting”. Though it is still the most prevalent method in determining coverage, many states are working to ban this process based on the ability of medical insurers to offer what many deem as “unfair” coverage.

In a survey conducted in December 2007 by the AHIP, *“Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits”, of the 1,547,207 individuals surveyed, 88.7 percent were offered medical insurance after being underwritten. Of the 88.7 percent, approximately 9 out of 10 were offered their requested policies at the standard or lower premium rates.  According to the survey, the premium rate did rise with the age of the applier, but roughly 75 percent of individuals 60-64 were still offered standard or lower premium rates.  Individuals with “condition waivers” (medical exclusions or “riders”) were only numbered at eight percent and of that, only four percent were offered higher premiums – approximately 12 percent of applicants were charge “smoker rates” based on the costs of covering smoke related issues.

Although it may seem like a daunting task, based on the survey, the majority of Americans are underwritten, offered the requested policy, and pay a standard or even lower premium rate. The key is to compare rates and coverage – which is where Health Insurance Online can help you.

Compare Costs of Different Medical Insurance Companies

Finding and choosing your medical insurance plan is perhaps the most time consuming part of purchasing your medical insurance. Where do you look? When you find it, how do you know it’s the right plan for you? What is the difference between an HMO and a PPO/POS? These are all important questions and if you’ve made it to Health Insurance Online, you’ve already made it to step two. How do you know if it’s right for you – you’ve researched and received your quotes and you’re trying to figure out just what it is you’re looking at and what you need.

An HMO, health maintenance organization, is different from other medical insurance policies due to how they manage the cost of medical care. They are similar due to the fact that they also require a co-payment and have yearly deductibles, but typically, this is where the similarity ends. An HMO will decide how much they will pay for any given service and will then seek out a medical care provider who will contract their services for the given amount. This is the “network” of an HMO. To be eligible for an HMO, policyholders agree to visit only doctors, clinics, and medical care providers within this “network”. This is what helps keep the cost down for HMO providers and policyholders. Should a policyholder decided to see someone outside of the network without approval, they may be responsible for the entire bill. HMOs are typically less expensive than a PPO, but also less flexible.

According the AHIP study, 78 percent of individual policies purchased were PPO/POS and 66 percent of family policies were also PPO/POS as opposed to the 6 percent (individual) and 5.5 percent (family) of HMO policies purchased in 2006-2007.(p. 16)

A PPO is a preferred provider organization and a POS is a point-of-service plan. According to the survey, most Americans want the flexibility to see the doctors of their choosing despite the typically higher cost associated with PPO/POS plans. With a PPO, the network is typically larger and available to a higher number of members than a traditional HMO. Members (policyholders) are also able to see physicians outside of the PPO network, the only cost being a higher co-payment versus potentially the entire cost. With a POS plan, members have many of the same benefits of a PPO, the difference being POS members are required to have a Primary Care Physician, or a main doctor. According to the AHIP survey, the average deductible for an individual purchasing PPO/POS plans was approximately $1,700 with only a third paying $2,500 or more in deductibles. In contrast, almost all individual HMO members had a $1,500 - $2,499 deductible or no deductible at all.

Individual Medical Insurance

For the vast majority of Americans, medical insurance meant getting a job for the medical benefits or government insurance. Now, more than ever, Americans are purchasing individual medical insurance policies that are tailored for their needs. In some cases, group plans through your employer are simply not enough, in other cases, you may not be eligible or meet the group requirements. In many cases, individual medical insurance simply offers policyholders to define what their own medical needs are and purchase plans that will cover them. As mentioned earlier in this article, perhaps your family has history of diabetes – it might be in your best interest to prepare for this in the event that it might possibly affect you or your future family.

In the AHIP survey, 9 out of 10 individual policies purchased included some type of behavioral medical coverage, substance abuse only slightly less.  Cancer screenings covered in individual policies was over 95 percent in PPO/POS plans and at 99.4 percent in HMO plans. Individuals as well as families purchasing medical insurance plans are given the option to weigh their decisions based on their own personal situations. With each additional benefit, such as dental, vision, maternity, and other valued services, that is added to a policy, the premium increases. Regardless higher costs, according the AHIP survey, Americans value the ability to choose for themselves what they deem valuable and needful of coverage.

Medical Insurance Premiums

Compared to 73 percent today, in 1999, employers paid up to 90 percent of employee medical care costs. As monthly medical insurance premiums rise, it is becoming more and more important for you to be aware of what your policy covers and just what is most important to you. Your monthly premium is largely dependent on your yearly deductible, making it imperative to understand the relationship between the two and what needs are important to you and/or your family. Depending on your monthly premium, you might pay anywhere from $0 to $7,500 or more in a year before you meet your deductible. Plans with a high deductible generally have much less expensive premiums – if your medical insurance company knows that you will cover the first $3,500, it is mutually beneficial to have a lesser monthly premium. In comparison, should you anticipate you or your family to be at a higher risk for medical care, you choose a lower deductible ton ensure your deductible is lower. Whatever your choice, take the time to be informed about your decision and how it will impact you and/or your family financially.