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USA: Health Insurance Plans
Group Health Insurance Plans
Depending on your profession and your kind of employment you may receive health insurance coverage from your employer through a group plan. This is often the less expensive option as your employer pays a part of your health costs.
On the downside, you will eventually lose your insurance coverage when you lose your job. The Consolidation Omnibus Budget Reconciliation Act from 1985 (COBRA) ensures that you can keep your health insurance for 18 months after you have lost your job but usually at a higher premium. In general, you usually enjoy the freedom to choose between different plans.
- Fee-for-Service Health Plan: You pay a monthly premium and a deductible to cover the costs for medical services. If costs extend the amount covered by your premium and deductible you will split the bill with your health insurance (co-insurance). You will have to file claims yourself and fill out different forms each time you receive medical services. This kind of plan offers the biggest choice in doctors and hospitals. Aside from basic coverage you can usually purchase additional plans which cover services not covered under the basic plan.
- Health Maintenance Organizations (HMO): This is a prepaid health plan which offers comprehensive healthcare in exchange for a monthly premium. You will not have to fill out claim forms. Instead just present your insurance card at your doctor’s office. One doctor will serve as your primary care doctor. You will need a referral from him if you want to see a specialist. Although your choice of doctors and hospitals is limited, HMOs sometimes make exceptions in a case of emergency.
- Point-of-Service Plans (POS): With this HMO type of plan, you have the option to use services and visit doctors who are usually not covered by your health insurance. If your doctor refers you, your health insurance will cover all or at least the biggest part of the costs. If you refer yourself outside of your plan, you will have to pay a co-insurance.
- Preferred Provider Organizations (PPO): This is a combination of the traditional fee-for-service plan and the HMO. If you use medical care providers in your network, you will just have to present your card and most of your costs will be covered. You choose your primary care doctor and will only have to pay co-insurance or a deductible for specific services. If you want to use a doctor outside of your health plan, you will have to file claim forms and cover a bigger part of the costs on your own.
Individual Health Insurance Plans
If you are not covered by your employer you will need to buy your own health insurance. Always remember that different insurance companies offer different benefits at different costs. If you are not fluent in English yet, find out if they provide customer service in different foreign languages. Although the Affordable Care Act should stipulate standards for minimum coverage that every insurance company has to abide by, you should compare different companies carefully. Try to find a policy which cannot be canceled by your insurance provider as long as you pay your monthly premium. Keep in mind to adjust your cost of living calculations accordingly. Here are some tips of what to keep in mind when looking for individual health insurance:
- Shop carefully
- Make sure your policy protects you from large medical costs
- Check to see what exactly the policy states (first day of coverage, waiting period, what is covered/ excluded)
- Make sure there is a “free look” clause (10-day trial period)
- Beware of single disease health insurance policies
A pre-existing condition is a health condition which you have before you apply for or enroll in a health insurance plan. It can be a serious disease but also a minor condition like mild asthma. Pre-existing conditions used to be the reason for very high premiums. Some insurance companies even denied coverage to people with pre-existing conditions altogether. Under the Affordable Care Act, this should not happen anymore. If all insurance providers abide by the new laws, however, remains to be seen.
No matter if you suffer from any kind of medical condition or not, you will have to report all of it to your new insurance company. They can cancel your insurance policy and that of your family if you forget to let them know about any condition you may have. There have been some cases in which insurance companies used this as an excuse to not cover severe diseases although they were unrelated to previous conditions. Although insurance companies cannot cancel your policy for this anymore under the new law, this might only apply to contracts which have been signed after 2010.
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