Frequently Asked Questions About Health Insurance

Buying a health insurance policy can be a confusing and time-consuming process, but well worth the effort, especially when it comes to having peace of mind and knowing that you and your family are protected in case someone becomes ill or gets involved in an accident.

At the same time, it’s important to thoroughly research and learn everything you can about your options before seeking health insurance coverage, whether it’s through individual coverage, a group policy, Medicare or Medicare supplemental insurance. Here are some frequently asked questions about health insurance that may prove helpful as you consider what kind of health insurance best fits your needs:

Among the most important reasons is to ensure that you and your family are protected against a serious financial loss and large medical bills should someone become ill or get involved into an accident. In addition to doctors, hospitals and medical groups, health insurance plans offered by such companies as Anthem Blue Cross and Blue Shield, an independent licensee of Blue Cross and Blue Shield Association, also play an important role in promoting quality health care for you and your family.

The easiest way to obtain a health insurance plan that best fits your needs and your budget is to talk directly to an insurance company, an insurance agent or an insurance broker, who can find a policy that provides the coverage you need at the most affordable price. If you work or are a member of a union or other organization, those groups may offer group health insurance, so check with their human resources department for more information.

An independent insurance broker is someone who can review health insurance policies from a number of companies, such as Anthem Blue Cross and Blue Shield, and find the policy that’s right for you. Their services are free to you because most health insurance companies pay brokers a commission on individual or group sales. Insurance agents operate much the same way. Most brokers and agents can be found by looking in the Yellow Pages or by asking friends and family for recommendations.

Generally speaking, there are two types of heath insurance, fee-for-service plans and managed care plans. In considering any plan, you should try to figure out its total cost to you and your family. The major differences between the two types of insurance involve choice of providers, out-of-pocket costs and how bills are paid. Usually, fee-for-service plans offer more choices of doctors and hospitals. These plans pay their share of the costs only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals and health care providers to give a range of services to members at reduced costs. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care plan. For those 65 and older, health coverage also can be obtained from Medicare.

That depends on a number of things. Health insurance costs vary depending on your age, health, the services you want covered and other factors. Group health insurance, which is often available through your employer, a union or other organization, often is cheaper than an individual health insurance policy. You should check with your company or organization to see about joining a group plan. If you buy individual insurance, buy a policy that will cover major expenses and pay them to the highest maximum level. If you need to save money, buy a policy with large deductibles or one that requires you to pay smaller costs out-of-pocket.

Normally, health insurance costs are paid in the form of monthly premiums, but other payment options can be arranged through your provider. Most policies also include a deductible, which you are responsible for paying.

A deductible is the amount you pay to a doctor or hospital before your health insurance provider begins to pay its share. Deductibles can differ from policy to policy.

Co-insurance is the amount you pay for health care and treatment after you pay your deductible. Co-insurance usually is a percentage of the cost, but depends on your policy.

Medicare is a federal health insurance program for people 65 years of age or older and certain younger people with disabilities. Medicare covers a portion or your hospital or doctor’s bill. Medicare Part A covers hospital costs and Part B covers the costs of your doctor. Additional information on Medicare can be obtained by going to the government’s Web site, www.medicare.gov.

Medicare supplemental insurance, sometimes referred to as Medigap, is an individual insurance policy that pays costs not covered by Medicare, which could include deductibles and co-payments. Many insurance companies, such as Anthem Blue Cross and Blue Shield, offer these types of policies.

Typically, health insurance will cover visits to your doctor or a hospital, most surgery or other treatments recommended by your doctors, as well as many out-patient or in-patient treatments. Again, the type of coverage varies depending on the policy.

No. Typically, dental and vision coverage require separate policies. Separate policies need to be purchased to obtain dental and vision coverage.

In certain cases, health insurance policies do offer a prescription drug benefit, but not all policies cover prescriptions, so check with your insurance provider or state insurance officials to find out what your policy covers. The same is true for Medicare and Medicare supplemental policies.

Where can I call to get further information about private health insurance, Medicare or Medicare supplemental coverage?

You can get answers to many of your health insurance-related questions by calling the Ohio Department of Insurance toll-free at 1-800-686-1526. If you have questions concerning Medicare or Medicare Supplemental Insurance, call the Ohio Department of Insurance at 1-800-686-1578.

Provided by Anthem Blue Cross & Blue Shield – Senior Midwest Division; Cleveland, Cincinnati/Dayton.