Medical insurance, or health insurance, is a system of financial protection against high medical costs. It covers physician visits, prescription drugs and hospital stays.

It has a monthly premium and an annual deductible, which is the amount you pay before the insurance company starts to cover costs. It also has different types of coverage. Look out more at WI Medigap insurance.

Types

There are several types of medical insurance coverage available. Most plans require that you pay a monthly premium in exchange for the plan covering a portion of your healthcare costs. Some plans also have a deductible, which you must meet before the plan begins to cover expenses. Other plans have copayments or coinsurance.

Preferred Provider Organization (PPO) plans are popular and usually offer a broad network of healthcare providers to choose from. These networks are negotiated by the plan to allow members to save on out-of-pocket costs by visiting providers that belong to the network. You can choose to visit providers outside the network but will likely pay more for this option.

Health maintenance organizations (HMOs) are another type of popular health care coverage. HMOs are often managed care plans, requiring you to select a primary care physician who will coordinate your healthcare needs. They may also require you to obtain a referral from your PCP before seeing a specialist.

Coverage

Health insurance plans offer a wide variety of coverage options. The best way to choose a plan is to assess your specific needs and find one that meets those needs. You should also look at the premium charged relative to the scope of coverage offered.

Coverage is impacted by several factors, including pre-existing conditions, age, location, and tobacco use. Your choice of health insurance provider will also have an impact on your premium.

You can buy a Preferred Provider Organization or HMO plan, which tend to have strict networks of doctors and specialists with whom they contract. These plans may require a referral from your primary care doctor before you see a specialist. You can also buy a plan that has a tier system, where you pay different amounts to see providers at each level. These plans typically have lower deductibles and out-of-pocket limits. A platinum plan is generally the highest cost but also offers the most comprehensive coverage.

Pre-existing conditions

Before the Affordable Care Act, medical insurance policies often had exclusions for pre-existing conditions. Typically, these were chronic or long term conditions such as diabetes, asthma, and cancer. These exclusions could last from 12-18 months or even for the rest of one’s life.

Since the passage of the ACA, pre-existing conditions haven’t played much of a role in medical insurance coverage. Individual/family plans sold in the individual market as well as small group health plans are required to be guaranteed issue. Premiums can vary only by age, zip code, tobacco use and family size, so applicants’ medical history no longer affects their ability to obtain coverage.

However, short-term medical plans and Farm Bureau plans as well as non-ACA compliant individual/family health plans can still deny an applicant’s application or impose higher premiums due to a pre-existing condition. These non-ACA compliant plans are also allowed to do post-claims underwriting, where they check the medical history of an individual after he or she has filed a claim.

COBRA

COBRA allows people to continue the health coverage they had through their employer even after they leave the company or lose eligibility for the plan. This is particularly helpful for people with ongoing health concerns or treatments that require consistent and reliable access to care.

The law requires that group health plans and employers offer qualified employees and their families the option to continue coverage for a limited period after employment ends. Individuals who meet the qualifications must receive a notice of their right to elect COBRA coverage. The notice must explain how to make the election and what options are available.

Choosing COBRA can be expensive, but it is usually less costly than the alternatives of going without insurance or buying individual health insurance on the market. COBRA coverage may also be tax deductible. It is important for individuals to explore their options carefully before deciding whether or not to continue their current coverage.