Learnings On Health Insurance And Different Coverage

Updated on March 5, 2021

Health insurance is one of the most crucial investments someone can make outside there. The truth is that illness, injuries, and a host of other medical setbacks can come unannounced. Some of them are challenging to handle and come with expensive hospital visits, surgery, and other measures. Essentially, that is where maintaining health coverage comes in handy by covering these medical costs. 

Unfortunately, some people are underrated or are not insured due to various reasons. This exposes them to expensive out-of-pocket payments and makes them vulnerable to more extended stays in hospitals, raising bills. Recent campaigns have encouraged people to obtain insurance cover as soon as possible, especially parents with families. That brings us to the need to enlighten people on the importance and essential details of health insurance. 

For someone to obtain a proper level of coverage, they must understand how health insurance works. Ultimately, this article explores that while getting deeper into the different coverage types and who deserves health insurance. 

Which Type of Health Insurance To Buy

Just any person should buy health insurance because of the unforeseen costly misfortunes that are bound for everyone. It is like everyone will find it challenging in one way or the other to cover medical expenses. So, it makes perfect sense that anyone living under the sun goes this route. Medical bills are some of the leading causes of related financial problems and consumer debts like home foreclosure and bankruptcy. 

Generally, people can choose between two types of health insurance. That is public health insurance like Medicaid, Medicare, and so forth. Another category is private health insurance. In most cases, people have private health insurance, and they can purchase them either through a marketplace or from their employer. Either way, whatever one chooses should meet some degree of cover and requirements. Some of them include:

Employer-Provided Health Insurance

These private plans are purchased and managed by employers, and often, people refer to them as group plans. Just like other private insurance plans, employer-provided health insurance should cover at the very least ten essential benefits. What sets group health insurance covers apart is the fact that they are generally affordable. Typically, group-shared plans that touch on a large pool are cost-effective due to the lower deductibles and premiums.

Short-Term Health Insurance

Short-term health insurance plans offer limited health coverage for a temporary gap. Crucial to note is that they do not count as qualifying health coverage. Also, they may not provide users with all the essential coverage. All the same, short-term health insurance is highly considered for anyone who needs short coverage within a specific duration. For instance, it makes perfect sense for someone looking for a new job or still waiting for his or her new job insurance to kick in to consider short-term health insurance. Plus, many are the health insurers outside there committed to offering short-term health insurance alternatives.


This federal health insurance program is for Americans above the age of 65. It offers either heavily cost-reduced or free health care to eligible individuals. Medicare is one of the most crucial insurance plans for the elderly in the United States. This health insurance coverage takes care of vast areas of concern. Part A for inpatient care ensures enrollees do not pay any premiums. Part B for outpatient care like doctor’s office visits attracts a monthly premium of $148.50. On the other hand, Part C allows users to buy into private health insurance, while Part D covers prescription drugs and some lab testing requirements.

Medicaid and Children’s Health Insurance Program (CHIP)

Low-income families are some of the individuals who can benefit from health insurance. And that is what Medicaid and the Children’s Health Insurance Program is here to address. This federal and state health insurance program is a perfect solution for low-income families and individuals. It does not only address the low-income families but also helps the caretakers of small children in need. Another distinctive feature of this health insurance program is that it takes care of children below 18.

Health Maintenance Organization Plans

These are some of the most popular types of health insurance someone can purchase today. The plan allows the entire network of health care providers to agree and offer their services. With this, the subscriber will choose a primary care provider to coordinate all the health services and care. Additionally, most HMO coverage takes care of most types of preventive issues such as unique visits. Still, the enrollee will have to pay copayment fees for every non-preventive medical visit with an annual deductible. Families and individuals that plan to see their primary care doctor more often for treatments and check-ups should consider HMOs.

Preferred Provider Organizations

With a PPO plan, everyone under the coverage can see any health care provider in the insurance company’s network. On most occasions, the enrollees will not choose a primary care physician or get referrals to see a specialist. More often than not, users will have copayments for non-preventive medical care they get and have an annual deductible. Also crucial to note is that Preferred Provider Organization Plans are perfect for individuals who are planning on seeing a specialist regularly. 

Exclusive Provider Organization Plans

Under the Exclusive Provider organization plan, enrollees have access to all the network providers, including specialists. One setback to note about Exclusive Provider Organization is that it will not offer coverage outside of the network except for emergencies. Individuals who don’t want to limit themselves to providers within a network will find this option suitable. Not only that but families and individuals that don’t want a primary care doctor to coordinate their care will undoubtedly go for this option.

Point of Service Plans

Point of Service is hybrid plans of HMOs and PPOs. Generally, this plan offers enrollees the chance to have a designated primary care physician for regular check-ups and referrals. Moreover, it allows the users to go for out-of-network providers if they are comfortable paying out of pocket. The option enables the enrollees to have copayments and deductibles at the same time. What makes it an exclusive option is the versatility and flexibility it offers to people willing to pay a bit more. 

High Deductible Health Plan

One thing to note about the High Deductible Health Plan is that it may include a PPO, EPO, or HMO plan. People have to meet the high deductible requirements before the health insurance coverage takes effect. The plans are excellent alternatives for individuals who want to save money with reduced monthly premiums and are not planning to use the coverage broadly.

On-Exchange Health Insurance

These options of health insurance coverages are sold on government-run exchanges. They must cover the ten essential benefits and any other additional services as required by the law.

Off-Exchange Private Health Insurance

These plans are sold either directly by the health insurance company, a privately-run health insurance marketplace, or a third-party broker. Off-exchange programs should meet the standards set by the Affordable Care Act and offer the ten essential benefits.

The Bottom Line

The above discussion discusses some of the common types of health insurance coverage. Make sure you have coverage for extended stays at hospitals and after hours clinics within the network. Also, it touches broadly on some of the crucial considerations and demands they come with regarding payment, benefits covered, and the limits they come with. While most of them have differences, one standing essence of health insurance coverage is to help people cover medical costs. Typically, health insurance is designed to share costs with enrollees until a certain point. On top of that, the insurance plans should meet affordability standards and cover the ten essential benefits. 

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The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.