Individual Health Insurance
There are two fundamental kinds of health insurance and they depend on how and if you are employed and how you buy it. These are individual insurance and group health insurance. Their costs and the way they work differ from each other.
If you work for yourself and not for a company, or if your company is too small to buy health insurance for its employees, you should buy individual health insurance. This is the type of health insurance that individual contractors or freelance workers usually buy. This kind of insurance is a policy you purchase directly from a health insurance company to cover yourself and possibly your family. You pay your premiums right to the insurer.
Because you are not part of a group or a pool of insured persons, as you would be if you had group health insurance, your individual insurance is often more expensive than group insurance.
Elements of Individual Health Insurance
Your individual health insurance should accomplish two goals. (These are the same for group health insurance.) It should pay for many health services that you would not ordinarily be able to pay for by yourself and cap how much you will have to pay.
After you have met your deductible and paid your co-insurance obligation, your total expense for medical care should be limited once you have spent a certain amount of money. For example, this cap might be $5,000 or $15,000. After that point, your insurer should be obligated to pay your remaining medical expenses.
Services that should be included are:
- Outpatient (other than a hospital patient) doctor visits
- Emergency care
- Prescription medication
- Laboratory and imaging exams
- Preventive care
- Maternity care
- Rehabilitation care
Be Certain What the Plan's Details Are
Beginning in the autumn of 2012, all insurers were required to give the insured person a standard form called "Summary of Benefits and Coverage." This form should enable you to compare important parts of all plans, such as descriptions of deductibles (how much you need to pay before your insurance pays), or what your co-insurance (paying a certain percentage cost of medical care) is. This summary must explain what the plan covers.
What If Your Insurer Doesn't Meet Its Obligations?
If your insurance company fails to pay for something described in its benefits and coverage section, you may want to contact a lawyer to help you get from the insurer what they legally owe you. Matthew L. Sharp is a Reno insurance attorney who represents individuals in all types of insurance bad faith claims.
It is especially difficult to battle your insurance company if you are sick and it refuses to pay. Contact Mr. Sharp to have a lawyer on your side who can win the fight for you.
The Affordable Care Act
Medical insurance coverage and how you pay for it has been undergoing large revisions. This began in 2010 when the Affordable Care Act was signed into law. Many new laws are being instituted that will govern how your insurance company pays you and what you owe in terms of premiums and payment for services.
Beginning in 2014, the Affordable Care Act will make affordable health insurance covering essential medical care available to almost all Americans. Some of the most important new rules that the act will institute in 2014 are:
- Guaranteed coverage: Health care insurers will no longer be able to deny someone insurance coverage because of that person's health or gender. Also, they will not be able to refuse to cover someone because of a pre-existing condition.
- Establishment of Exchanges: The act will require that by 2014, all states "must have an insurance exchange — an organized marketplace where individuals and small-business owners can view, compare and purchase qualified health plans." Each state will have the choice of whether to set up an exchange itself or have the federal government do it for them.
- Individual Mandate: Everyone will be required to buy health insurance that provides any type of legitimate coverage. These types would include individual insurance you buy for yourself or group insurance that is provided through your job, Medicare, Medicaid, CHIP (Children's Health Insurance Program), Veterans Affairs, or Tricare (health insurance for the military).
- Paying a Penalty: Everyone, with some exceptions, will have to pay a tax penalty if they don't have health insurance in 2014. The exceptions are: if you make too little money to file a federal tax return; if you would have to spend more than eight percent or your household income on the cheapest qualifying plan, even including subsidies; you are an American living abroad; you are in prison.
- Individual subsidies for those who buy on an exchange as individuals depending upon their level of household income compared to a percent of the poverty level.
- Medicaid, the government program for low-income Americans will be expanded to cover another 16 million people.
To learn more about the responsibilities of an individual health care provider, or if you would like to discuss a possible claim involving insurance bad faith, contact Mr. Sharp today. He represents individuals in Reno and throughout the state of Nevada in a broad range of claims and will make sure you get the compensation you are owed. Call (888) 640-0835 to schedule a consultation today.
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