Health Insurance 101

Health insurance covers the costs associated with illness and injury. It often also covers the cost of preventing illness, such as annual physical exams and vaccinations. Health insurance can include vision insurance.

You can obtain health insurance despite a pre-existing health condition. There may be a period of time (a waiting period) during which your current condition is not covered.

Until you obtain health insurance coverage, you are known as an "uninsured" person. There are steps for an uninsured person to take to help minimize the cost of using the health care system. Steps include obtaining a medical discount card and/or short term health insurance for a limited period of time. Free or low cost medical care is also available.

If you need help paying for health insurance premiums or other costs relating to your health insurance, financial assistance is available.

Instead of a standard universal health coverage, we currently have a mishmash of different types of private health insurance policies and public health insurance programs such as Medicare and Medicaid. This discussion focuses on the private sector.

At the one extreme is the old model of health insurance known as Fee-For-Service (indemnity) type policies. In a Fee-For-Service policy, the insured has free choice about which health care services to use. The insured pays the bill and is reimbursed by the insurance company. At the other extreme are HMO and other managed care type policies. In these types of policies, care is managed by the insurance company. Consumer choice is limited.

There are many types of policies between these two extremes which combine features of both types.

There are advantages and disadvantages to each type of policy.

There are no studies which indicate whether a particular type of policy is better for a person with a particular health condition. Studies do show that people with a chronic or serious health condition can receive as good care under a managed care plan as under a Fee-For-Service plan.

We have a Health Plan Evaluator to help make a reasoned decision  about which policy is best for you if you have a choice of health insurance plans. Our Evaluator will help you choose which policy is best from the point of view of a person with your health condition and your individual needs.

Also consider speaking with a financial planner or an insurance broker who has experience with people with a serious health condition.

To be a wise health care consumer and to maximize use of a health insurance policy, it is useful to understand the concept behind the policy, as well as the terms generally used.

If an insurer refuses to allow you to obtain a service you need, or refuses to pay a claim, appeal. Most appeals turn a "no" into a "yes." According to the experts, the key is to be persistent. If all else fails, you can complain to the insurance regulators - and ultimately access the court system.

NOTE: In addition to health insurance, other insurance products which cover health are Hospital Indemnity Insurance, Accidental Death and Dismemberment Insurance and Cancer and other specific illness policies. Long term health care is provided by Long Term Care policies.