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A Look at Health Insurance: Reasons to Get Covered and Follow the Rules

Health-Insurance-ChangesWith the Affordable Care Act going into full force in 2014, the spotlight has really shone on the nation’s health insurance reality. The cost of health care has skyrocketed in the United States, and if you are currently uninsured or inadequately covered, falling ill or suffering a serious injury could become a catastrophic financial event. Therefore, you need to do your research and also talk to your physician to find out more about the best health insurance plan to fit your particular needs.

Underinsured and Overpriced

The disparity in prices seen across the spectrum is a stark reminder of the need for health coverage. If you have a private health insurance plan, not only will your insurer foot much of the bill, the overall cost will be lower.

In the United States, hospital retail prices vary by as much as 500 percent, and some rates are up to 10 times what is charged to Medicare. For example, pneumonia care is $8,000 to $11,000 on Medicare but can cost almost $60,000 in certain hospitals. For major joint replacement, the Medicare charge is $13,000 to $20,000, but the same joint replacement can cost over $80,000 in some hospitals.

While hospital executives claim virtually no one pays the retail or “chargemaster” rates, those who are underinsured or uninsured see very high bills they are often unable to pay. In contrast, private health care insurance plans negotiate extremely steep discounts.

Why You Need to Follow the Rules

There is a little bit of “rebel” in each of us, but when it comes to health insurance, it’s best to play it safe. The Centers for Disease Control and Prevention say more than 80 percent of Americans see a doctor at least once a year, so this alone is an excellent reason to choose a primary care physician (PCP).

Most health insurance policies require you to choose a PCP, and if you receive care elsewhere, you are the one who has to pay. If you obey the rules and diligently go to your PCP for care and referrals to specialists, your insurer will also play ball and cover the cost of your treatments.

A Point of Service (POS) plan requires you to use medical facilities and providers that are part of your insurer’s network. You can’t see a specialist without being referred to one by your PCP, but you do receive the full benefit of your coverage. A Network Plan also involves playing by the rules and agreeing to the terms and conditions of your insurance policy.

Relax and Save

If you find physicians who are part of your plan’s network, you may benefit from the “allowed amount” stipulation, which means a doctor accepts what your coverage pays even if it is less than what he wants to charge. So if he charges $100 but the allowed amount is $75, the physician will accept the lower charge if he is part of your insurer’s network.

The Affordable Care Act has helped reduce the number of uninsured Americans, and an estimated 80 percent of those who purchased insurance under the new legislation are satisfied with their decision. Play it straight with your health insurance and reap the rewards of affordable premiums and excellent coverage.

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