让我们面对现实吧——在当今世界，医疗保险是必需品. 事实上，大多数美国人.S. citizens and legal residents must have qualifying health insurance or face a penalty tax. 然而，医疗费用每年都在飙升, 这变得越来越困难(在某些情况下), 不可能)自掏腰包支付医疗费用. 无论你是否已经有了健康保险，还是想要得到它, 这里有一些基本的信息来帮助你理解它.
不是团体的一部分? 你可能得自己去了
You may have group health insurance or be able to buy it through your employer. 团体保险通常由雇主提供. It is also offered through some civic groups and other organizations (e.g.、汽车俱乐部、商会). 一份保单涵盖了一群人的医疗费用. All eligible members of the group can be covered by a group policy regardless of age or physical condition. The premium for group insurance is calculated based on characteristics of the group as a whole, 如平均年龄和职业危害程度. 它通常比个人保险便宜.
如果你不能加入团体，可以考虑购买个人保险. 不像团体保险, individual insurance is purchased directly from an insurance company or agent. When you apply, you are evaluated in terms of how much risk you present to the insurance company. Your risk potential will determine whether you qualify for insurance and how much it will cost, 取决于州法律. 你必须自己付全部保险费.
如果你必须一个人去, you can shop for health insurance coverage through state-based Affordable Insurance Marketplaces. 你可以根据价格和质量来比较健康计划, and ultimately purchase an affordable plan that best meets your health insurance needs.
知道外面有什么
The cost and range of protection that your health insurance provides will depend on your insurance provider and the particular policy you purchase. You may have comprehensive health insurance that involves several types of coverage, 或者包括医院在内的基本保险, 外科手术, 以及医生的费用. In addition, major medical coverage is necessary in the event of a catastrophic accident or illness. Many plans also cover prescriptions, mental health services, and other health-related activities (e.g.、健身俱乐部会员).
When it comes to health insurance, HMO, PPO, and POS are more than just letters. You need to know the types of health plans available so that you can make an informed decision. You can obtain health insurance through traditional insurers like Blue Cross/Blue Shield, 健康维护组织(hmo), 首选提供者组织(PPOs), 服务点(POS)计划, 和独家供应商组织(epo).
- Traditional insurers: These plans usually allow you flexibility regarding choice of doctors and other health-care providers. 有些保单会报销你的报销费用, 而其他人则直接向医疗服务提供者付款. You will pay a deductible and a percentage of each bill, known as coinsurance.
- HMOs: Health maintenance organizations cover only medical treatment provided by physicians and facilities within their networks. 你必须选择一位初级保健医生, 谁会批准或拒绝任何看专科医生的请求. You usually pay a fixed monthly fee for health-care coverage, as well as small co-payments (e.g.，每次诊症及处方收费$10).
- PPOs: Preferred provider organizations do not require members to seek care from PPO physicians and hospitals, but there is usually strong financial incentive to do so (in terms of percentage of reimbursement). You usually pay a fixed monthly fee for health-care coverage, as well as small co-payments (e.g.，每次诊症及处方收费$10).
- POSs: Point of service plans combine characteristics of the HMO and PPO. 你必须选择一位初级保健医生 to be responsible for all of your referrals within the POS network. Although you can choose to go outside the network with this type of plan, 你的医疗保险将在一个较低的水平.
- EPOs: Exclusive provider organizations are basically PPOs with one important difference: EPOs provide no coverage for non-network care.
阅读合同
You should have a basic understanding of what your policy does and does not cover. This may help you prevent an unexpected medical bill from arriving in your mailbox, 因为你会提前知道, 例如, 是否包括抽脂. You must read your policy carefully, particularly the section on limitations and exclusions. 具体内容因政策而异. In general, though, most policies will at least mention the following:
- Pre-existing conditions: An illness or injury that began or occurred before you obtained coverage under the policy. The Affordable Care Act eliminated the ability of a health insurance policy or plan covering essential health conditions to deny coverage for pre-existing conditions. However, pre-existing conditions may be imposed for other than essential health benefits.
- Nonduplication of benefits: Benefits will not be paid for amounts reimbursed by other insurance companies.
Your health insurance policy should also address the following issues:
- Deductible: The amount that you must pay before insurance coverage begins (usually an annual figure
- Coinsurance: The portion of each medical bill for which you are responsible
- Co-payment: The fixed fee that you pay for each doctor visit or prescription
- Family coverage: Many group plans allow you to cover your spouse and dependents for an increased premium
- Out-of-pocket maximum: This provision is designed to limit your liability for medical expenses in the calendar year; you won’t have to make coinsurance payments in excess of this figure
- Benefit ceiling: The maximum lifetime payout under the insurance policy, usually at least $1 million
总之, having health insurance is an important aspect of every person’s life and financial plan. There are many options to choose from and being armed with some basic information can help you evaluate what is right for you and your situation.
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