With laws changing and options narrowing, health insurance can be frustrating and confusing. We help you find the best plan at the right price. And we always keep up with the changes so you don’t have to.
At Carolina Health & Medicare Associates we will get your questions answered, find a plan that fits your needs and budget and we simplify the enrollment process. We are here every step of the way and throughout the year.
What is health insurance?
Health insurance is a contract with an insurance company, which agrees to pay some or all of your medical bills based on your “coverage,” or the terms of your policy. In exchange, the insurer is paid a set amount of money — a “premium” — on a regular basis. Most Americans have private health insurance, either through their employer’s group plan or through buying their own individual policy.
Why do I need health insurance?
It’s no secret that health care is expensive today. . Without insurance, many Americans would be one health setback away from financial dispair. Regularly paying a set premium for health coverage assures that money will be available to minimize the cost of everything from routine checkups to catastrophic medical bills.
What’s the difference between a deductible, a copayment and coinsurance?
All three are medical charges you pay out of your own pocket. Plans may have separate individual and family deductibles and/or deductibles for separate services such as hospitalization. A copayment is a fixed amount you pay toward each medical service, such as $25 for a checkup. Coinsurance is a fixed percentage, rather than a flat amount, that you pay toward medical care.
What is the difference of a PPO and HMO network?
A person enrolled in an HMO plan must select a single primary care physician. All health care services go through that doctor. A referral is necessary if the person wishes to see any other health care professional, and visits to health care professionals outside the network are not covered by the plan.
However, there are certain exceptions, including emergencies. Another typical exception is routine service visits to see an obstetrician/gynecologist within the network for routine services, such as Pap tests and obstetrical care.
PPO plans allow people to go to whatever health care professional they wish without a referral. This includes professionals both inside and outside the network. However, remaining inside the network ensures full coverage and means less out-of-pocket costs.
Coordinating care through a single doctor means there is less paperwork and lower health care costs associated with HMOs. But for people who want to see particular specialists, PPOs are the better option.