What are my health care options?

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What are my health care options?

Health insurance can be complicated and confusing. There are different types of plans:
Private Health Insurance

There are two major types of private health insurance:

1. Fee-for-service. The provider (such as a doctor or hospital) gets paid for each covered service. With this type, you go to a doctor of your choice, then the doctor or hospital submits a claim to your insurance company for payment. The insurance company will only pay the provider for “covered” services. Most fee-for-service plans have a deductible amount that you must pay each year before the insurance company will begin to pay for medical services. Many plans also require you to pay a portion of the medical expense—called “coinsurance.”
2. Managed care. Managed care plans have contracts with certain doctors, hospitals and other providers to provide medical services to plan members. The three main types of managed care plans are:

* Health Maintenance Organizations (HMOs). They provide health services for a fixed monthly payment, called a “premium.” This monthly premium is the same whether you use the plan’s services or not. The plan may charge a copayment for some services—for example $10 for an office visit or $5 for a prescription. HMO plans usually require you to select a primary care physician (PCP), who manages your care. As long as you use the doctors and hospitals that participate in the HMO, your out-of-pocket costs should be very small. The HMO Act of 1973 created this alternative to traditional health plans as a more affordable option.
* Preferred Provider Organization (PPO). This option offers more choices than an HMO, but premiums often are higher. Most PPO plans do not require you have a PCP to manage your care. You can keep your out-of-pocket costs low by using “in-network” providers.
* Point of Service (POS). This plan is similar to a PPO, but your care is managed by a PCP. For example, with a POS plan, you would need a referral from your PCP to see a specialist.

People who have private insurance either buy it themselves or get it through their employer, called “group insurance.” Group insurance obtained through an employer typically requires the employee to pay some of the overall policy cost.

Public Health Insurance (Please prefer video top of this FAQ)

The government also provides health care coverage for qualifying women through Medicaid, Medicare, and special interest programs. These plans serve those who meet certain financial, age, or situational requirements. Government health insurance programs include:

* Medicare. This is the national health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure. How you get your health care coverage depends on the Medicare plan you select. The Original Medicare Plan has three parts:

* Part A (hospital) covers inpatient hospital, skilled nursing, home health, and hospice services. Everyone over age 65 is entitled to Part A.
* Part B (medical) covers outpatient hospital, doctor, lab, and other services. Part B also covers preventive services important to women, such as yearly mammogram, Pap smear, bone density scan, and flu shots. Part B is optional. You have to purchase Part B.
* Part D covers prescription drugs. Part D is optional. You have to purchase Part D. Private companies approved by Medicare run these plans. Plans cover different drugs, but drugs that you must have to treat a health problem are covered.

Some people also choose to purchase a “Medigap” policy to help pay for medical services and supplies not covered by Part A and Part B. Costs for this type of private insurance vary by policy and company.

Medicare also offers Medicare Advantage Plans. These are health plans like HMOs and PPOs that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” These plans provide all of your Part A and Part B coverage. Many also include Part D drug coverage. Your costs may be lower than in the Original Medicare Plan, and you may get extra benefits.

For more information, call 1 (800) 633-4227 (MEDICARE) or go to http://www.medicare.gov.

* Medicaid. Medicaid provides health care to certain low-income individuals and families with limited resources. Medicaid does not pay money to you. Instead, it sends payments directly to your health care providers. Medicaid is a state and federally funded program. Although the federal government sets general program rules, each state defines its own eligibility rules and runs its own program services. Qualification in one state does not mean you will qualify in another state. You must be a U.S. national, citizen or permanent resident alien in order to apply for benefits. For more information, call 1 (877) 0267-2323 or go to http://www.cms.hhs.gov/home/medicaid.asp

Note: Many states have become more flexible in their ability to serve families in need, especially if you fall into any of these categories:

* Pregnant—Both you and your child will be covered if you qualify.
* Children/Teenagers—May cover sick children or teenagers on their own.
* Aged, Blind, and/or Disabled—Nursing home and hospice care available.
* Leaving welfare—You may be able to get temporary assistance.

Call your local social security office for more information.

* State Children’s Health Insurance Program (SCHIP). This is a joint state and federal program that provides insurance for children of qualifying families. Families who make too much money to qualify for Medicaid but cannot afford private health insurance may be able to qualify for SCHIP assistance. Eligibility and health care coverage varies according to each state. For more information, contact http://www.insurekidsnow.gov or call 1 (877) 543-7669 (KIDS NOW).

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