Research health insurance options before deciding

What you should know:

A health insurance policy is a contract between an insurance company and a person or a sponsoring group, such as an employer or government agency.
Most plans have a network of providers. Generally you pay less for care if you use an in-network provider. These providers agree to receive a lower payment for care to insured patients.
Health insurance policies are usually renewable annually. The premium is the amount the policy owner pays each month for health insurance. If you have individual insurance, you pay the entire premium-which might be very high if you have a chronic health condition. If you have group insurance you often pay only a portion of the premium.
Health insurance often requires costs beyond premiums. The deductible is an amount an insured person pays for care before the carrier begins paying. The copayment is a fixed amount you pay at each visit or procedure or for each prescription before the carrier pays. Coinsurance is the percent of all covered health expenses that an insured person must pay(often 20 percent) after the deductible has been met. The insurance plan covers the balance(often 80 percent).
Insurance companies have rules that may exclude payment for certain services. They also may require an authorization, referral or second opinion before allowing coverage of services. Rules might be waived temporarily for emergency care but may require notification of the carrier within 24 to 48 hours after the emergency.
Many employers offer group health insurance as part of their employee benefits packages. Employers usually have an open enrollment period each year, when employees can sign up for coverage, change coverage or add dependents to the plan.
Group insurance has several benefits. The sponsor, such as the employer or government, usually pays a large portion of the premium. Group policies often cost less per person because they spread out the risk among a lot of people, many of whom are will. In most cases, the insurance company agrees to insure everyone in the group, regardless of their condition or health history.
The average family health insurance premiums often costs more thatn $12,000 a year. The premium and out-of-pocket costs have increased greatly over the last eight years and are expected to grow.
Many people are denied health insurance or can't afford it. Many spouses and kids lose insurance coverage after a divorce. People often lose their health insurance when they lose their jobs. The cost of continuing a temporary policy(COBRA benefits) without the help of an employer can be exorbitant.
People without insurance often resort to extremely expensive emergency room care. Others do without needed care.
Many health insurance reform advocates want changes in the U.S. health insurance system including
(1) Ending discrimination against people with pre-existing conditions
(2)Preventing insurance carriers from dropping coverage on very sick people.
(3)Stabilizing and protecting Medicare and making needed prescription medication a covered benefits all year long.
(4)Preventing annual or lifetime limits on insurance coverage that cause many families to go bankrupt.
(5)Increasing access to preventive services to find health problems early when they are less costly and easier to treat.

What you should do

Choose your health plan and care providers wisely. Check their ratings, credentials, accreditations and reputation.
Before choosing a plan, find out if it will cover your needs and the costs. Make sure pre-existng conditions and the providers you need are covered.
Follow the rules of your plan. Know what your plan covers.
Be sure your providers get the required authorizations or referrals. Ask providers to make the required notifications to the carrier after an emergency.
Take charge of your health. Be involved in decisions about your care. Keep careful records of referrals, approvals, names of phone contacts and explanations of benefits.
Know your rights. In a true medical emergency, you have the right to be treated in a hospital, regardless of whether you have insurance.

source: Family Health...Take Charge provided by Memphis Common Table
healthymemphis.org