Health Insurance

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Health insurance helps you to be protected from inability to pay for health care and from expensive medical bills.

Under the care law, all insurance policies must cover 10 important health benefits.

Health Insurance

In addition, all people are required to have basic health insurance if they are not subject to fines. This can change under Trump's policy, but for now, that is what is applied.

You can buy health insurance through your boss, if your boss offers health insurance in return.

Buying insurance from your boss sometimes offers better coverage than buying yourself because your boss bears a large percentage of the premium and you only pay a small fee, which is taken from your income tax.

You can also buy health insurance through the health insurance market, also known as an exchange market, directly from an insurance company, or through an insurance broker that goes around looking for customers.

If you buy health insurance through an exchange, you have the right to receive income from subsidies that make premiums more affordable. Regulations regarding subsidies can change depending on President Trump and the congress so insurance regulations can also change.

You must register insurance as long as the registration is opened unless you fulfill the requirements such as being married or having children.

In addition to getting 10 important health benefits - such as doctor visits, emergency services, laboratory services, mental health services and addiction treatment, rehabilitation services and devices, pediatric services, prescription drugs, prevention of diseases and treatment of chronic diseases, births and baby care newborn - each category has special coverage that can differ based on state regulations and is based on insurance companies and special coverage. For example, some coverage may include acupuncture and chiroptactic treatment, while others do not.


As an insurance policy holder, here are the fees you will pay:
Premium: Insurance premium is the monthly fee that you pay for health insurance.

This fee will vary depending on age, country, insurance company and how much insurance coverage.

Under current law, the insurance does not depend on your health status, but the law can change at any time.

Reduction: Reduction is the amount you have to pay from your own income before the insurance company starts paying the percentage of compensation. Your premium does not include deductions.

Co-insurance: co-insurance is the percentage of bills that are accounted for after deducting deductions. For example, if your insurance provides 80% co-insurance and health care gives you a $ 200 bill, the insurance company will pay 80% of the bill, or $ 160, and you will pay the remaining 20%, or $ 40.

Co-insurance is generally related to the PPO plan. Co-insurance is cheaper if you are in a network provider and more expensive when you are outside the network provider.

You can have 80/20 co-insurance on the network and 60/40 co-insurance outside the network.

Co-payment: co-payment is a fixed dollar payment paid when visiting a health care provider or buying a prescription. Co-payments are generally related to HMO insurance.

Out of pocket maximum: out of pocket maximum or out of pocket limit is the most paid fee for health care bills every year before the insurance company takes over and pays 100% of the rest of your bill.

Out of pocket maximum cannot be included in a special year when you are healthy, but it can be a savior if you are sick and need a lot of care.

Why buy insurance if it will make the burden of payment more and more? Because without insurance, if one day you experience an adverse event such as a dangerous disease and you cannot afford the medical expenses, your life will be threatened.

You might be able to try to pay for the payment temporarily but then end in bankruptcy.

The doctor will not care unless you can pay a down payment for treatment. With insurance, your responsibility to pay for medical is limited to several thousand dollars per year - an amount that some people still cannot afford to pay, but many will do it because it is an urgent need.

The cost level for each type of burden that you bear depends on what plan you have.

Generally, the more premiums you pay, the less you pay for medical expenses, and the less you pay premiums, the more you pay for treatment.

Types of Health Insurance

There are several types of health insurance that can be chosen. Each insurance has advantages and disadvantages out of pocket.

Health Care Organization

Health care organizations (HMOs) have contracts with various health care providers who reduce costs for insurance providers and insurance holders.

Each insurance holder must choose a primary service provider, namely a man or woman who will visit for any health problems. PCP will explain the patient to an HMO network specialist if needed.

If the patient wants to see a doctor outside the HMO network, insurance will not want to do it. However, the cost of meeting a network of service providers is relatively low.

HMOs have low premiums, low co-payments and no deductions. If saving is your main concern and you are not voter with the service provider you meet, HMOs can be the right choice for you.

Special Provider Organization

A special provider organization (PPO) also has contracts with various types of health care providers that reduce costs for insurance providers and insurance holders.

All of these are PPO network service providers, and policyholders will pay less to visit the service provider. However, unlike HMOs, PPOs still provide services to meet specialists.

PPOs tend to have higher premiums than HMOs. They also have an annual reduction to find network service providers both inside and outside plus go-insurance for each visit.

If freedom of choice is more important to you than costs, PPO can be the right choice.

Compensation Insurance or Service Fee Insurance

Compensation insurance, also called cost insurance for services, does not have a network for health care providers with whom the tariff is negotiated.

This insurance does not have a co-insurance or co-payment reduction. The insurance provider will cover a portion of your medical expenses which are covered at the normal, reasonable and normal level.

This insurance offers freedom in choosing safe health care that you will visit. However, the price may be more expensive than PPO or HMO.

Point-of-service (POS) Plan

Point of service plan is often referred to as insurance that combines the features of HMOs and PPOs. This insurance requires you to choose the main network of doctor services and get direction to visit specialists, such as HMOs.

But this plan offers coverage at low rates for services outside the network, such as PPO.

There is no reduction in deep network services and high reduction for outside network services. This insurance does not have co-payments.

Disaster insurance

Health insurance is an option for adults less than 30 and adults who get assistance from the government from receiving insurance.

Disaster insurance can be a PPO or HMO. This insurance has a low premium but maximum out of pocket and reduction.

This insurance is designed for all people with very low income and people who are young, healthy and do not need to use health insurance for treatment from minor illnesses or periodic examinations.


Each type of insurance can have a high abatement fee as long as it has a minimum reduction of $ 1300 for individual insurance or $ 2,600 for family insurance.

HDHP has a smaller premium in exchange for the reduction. The main advantage of having HDHP is the ability to combine it with a health savings account, which allows you to pay tax-free medical fees.


Flexible shopping reekening is not one type of insurance, these accounts provide benefits for some superiors in offering assistance in paying medical fees beyond the ability of employees to be taken from pre-tax income.

In other words, this insurance is useful as a supplement for HMOs, PPOs or other insurance.


Medical care is a federal government subsidy program aimed at serving the elderly.

This service offers coverage at a low cost for hospitalization, surgery, doctor visits, prescriptions and others.


Medicaid is a health program funded jointly by the federal government and state governments to serve people and low-income families.

This insurance also provides care for people with disabilities and disadvantaged elderly people.


The child health insurance program (CHIP) is also co-funded by the federal government and the state government.

This program provides health insurance for young people less than 19 whose parents cannot afford the health coverage of their children but are eligible for medicaid.

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