FAQ's

Do I need health insurance?

An illness or accident could generate thousands of dollars in medical bills. Health insurance protects you from carrying the financial strains of medical care by yourself and allows you to pick preferred providers. Without insurance, you alone are responsible for your health care bills, and if you die, these bills may be deducted from your overall estate. While every hospital must accept emergency patients despite insurance, some hospitals can refuse ongoing care or recovery care if you do not have health insurance.

What are the main types of medical insurance?

There are four basic types of insurance:

Fee-for-Service Plans involve paying a monthly premium for health insurance. Medical providers send you bills, which you submit to the health insurance company. Fee-for-service coverage is usually the most expensive, includes deductibles and out-of-pocket expenses. It usually has an 80/20 split, in which the insurance provider pays 80% and you pay 20%. With this plan you can choose any doctor.

Health Maintenance Organizations (HMOs) have no deductibles and no claim forms. HMOs are generally less expensive than fee-for-service plans. If you are enrolled in an HMO, you are able to choose from a network of physicians. However, if you want to see a doctor or specialist other than your primary care provider (PCP), your PCP must refer you.

Preferred Provider Organizations (PPOs) are networks of doctors and hospitals that charge a fee for service. You can go outside of the network, but the fees are higher. With PPOs there are deductibles and out-of-pocket expenses, usually an 80/20 split.

Point-of-Service Plans (POSs) are a combination of HMOs and PPOs. They act like an HMO when you visit doctors within the network, but when you go outside the network, they work like a PPO.

What is a pre-existing condition?

A pre-existing condition is an injury or ailment that was treated before the current policy became effective. Sometimes this includes a medical condition that you were aware of, but didn’t seek treatment under your previous medical plan. Health insurance policies exclude and accept pre-existing conditions differently, so check the details of potential plans closely

What is COBRA insurance?

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) requires employers to extend health coverage for 18 months after an employee leaves a job. Coverage may be extended for up to 36 months for the employee’s spouse and children only in the case of the employee's death.

This type of coverage can be very expensive, but it gives you an opportunity to continue your health insurance until your policy with your new employer begins. If you want to be covered by COBRA, you must request it from your employer within 60 days of leaving your job.

What does Medicare cover?

Medicare is broken down into two parts: Part A and Part B.

Part A (Hospital Insurance Plan) helps pay for:

  • Hospitalization stays: Semi-private room, meals, general nursing and other hospital services and supplies (but not private-duty nursing, a television or telephone in your room, or a private room unless medically necessary).
  • Home health care: Intermittent skilled nursing care, physical therapy, occupational therapy, speech language pathology services, home health aide services, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers), supplies and other services.
  • Hospice care: Pain and symptom relief and supportive services for the care of a terminal illness. Home care is provided. Also covers necessary inpatient care and a variety of services usually not covered by Medicare.
  • Skilled nursing facility care: Semi-private room, meals, skilled nursing, rehabilitation services and other services and supplies.
  • Blood: From a hospital or skilled nursing facility during a covered stay.

Part B (Medical Insurance Plan) helps pay for:

  • Medical expenses: Doctors’ services, inpatient and outpatient medical and surgical services and supplies, physical, occupational and speech therapy, diagnostic tests and durable medical equipment.
  • Clinical laboratory service: Blood test, urinalysis and more.
  • Home health care: (under certain conditions) Intermittent skilled care, home health aide services, durable medical equipment and supplies and other services.
  • Outpatient hospital services: Services to find or treat an illness or injury.
    Blood: As an outpatient, or as a part of a Part B covered service