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Health insurance

Health care costs are high, and getting higher. Who will pay your bills if you have a serious accident or a major illness? You buy health insurance for the same reason you buy other kinds of insurance, to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very expensive.

Group Insurance
Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.
Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), for example
What happens if you or your family member leaves the job? You will lose your employer-supported group coverage. It may be possible to keep the same policy, but you will have to pay for it yourself. This will certainly cost you more than group coverage for the same, or less, protection.
A Federal law makes it possible for most people to continue their group health coverage for a period of time.
Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization. Many organizations offer health insurance plans to members.

Individual Insurance
If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy. You can get fee-for-service, HMO, or PPO protection.
If you get a noncancellable policy then you will receive individual insurance under that policy as long as you keep paying the monthly premium. The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out. But it doesn't protect you from losing coverage.

Fee-for-Service
This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country.
With fee-for-service, the insurer only pays for part of your doctor and hospital bills. This is what you pay:
· A monthly fee, called a premium.
· A certain amount of money each year, known as the deductible, before the insurance payments begin. In a typical plan, the deductible might be $250 for each person in your family, with a family deductible of $500 when at least two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you have count toward your deductible. Only those covered by the policy do. You need to check the insurance policy to find out which ones are covered.
· After you have paid your deductible amount for the year, you share the bill with the insurance company. For example, you might pay 20 percent while the insurer pays 80 percent. Your portion is called coinsurance.
There are two kinds of fee-for-service coverage: basic and major medical. Basic protection pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. Basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visits. Major medical insurance takes over where your basic coverage leaves off. It covers the cost of long, high-cost illnesses or injuries.
Some policies combine basic and major medical coverage into one plan. This is sometimes called a "comprehensive plan." Check your policy to make sure you have both kinds of protection.
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Health Maintenance Organizations (HMOs)
Health maintenance organizations are prepaid health plans. As an HMO member, you pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.
The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when medically necessary.
There may be a small copayment for each office visit, such as $5 for a doctor's visit or $25 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.
Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the doctor's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan.
In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive. This is one way that HMOs can limit your choice.

Preferred Provider Organizations (PPOs)
The preferred provider organization is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from. When you use those providers (sometimes called "preferred" providers, other times called "network" providers), most of your medical bills are covered.
When you go to doctors in the PPO, you present a card and do not have to fill out forms. Usually there is a small copayment for each visit. For some services, you may have to pay a deductible and coinsurance.
As with an HMO, a PPO requires that you choose a primary care doctor to monitor your health care. Most PPOs cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammograms.
In a PPO, you can use doctors who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms). Some people like this option because even if their doctor is not a part of the network, it means they don't have to change doctors to join a PPO.
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Read the rest of the book at Questia online library.
State Health Insurance Market Reform: Toward Inclusive and Sustainable Health Insurance Markets
Book by Routledge, 2004

Preface
Although the increasing size of the uninsured population in the United States remains an ongoing public concern, there is currently little prospect of system-wide health care reform to address the failure of private health insurance markets to respond to this important policy issue. However, for nearly two decades, state governments have implemented reform of their small-group and individual health insurance markets with the intent of ensuring access to affordable and stable health care coverage. Such reform has been accompanied by keen interest from researchers and policymakers alike as to whether this type of intervention can address the selection and pricing practices of private insurers that have been perceived as limiting the availability of coverage, especially to individuals with health problems. Policymaker interest has stimulated a variety of research on the primary impact of reform on health insurance coverage rates, for both the general population as well as those groups specifically targeted by reform, and on secondary effects of reform regarding labor market outcomes and the structure of private insurance markets. To date, however, there has been little effort to provide a critical assessment of these research findings, their applied methodologies, and the implications of such research for public policy.

The confluence of the broad interest of policymakers and researchers across the country in scrutinizing the impact of insurance regulatory reforms and the specific motivation of decision makers in New Jersey to critically revisit their own pathbreaking regulatory strategy provided the motivation for assembling the chapters in this volume. New Jersey was among the first states to implement comprehensive access and rating regulations in its individual and small-group health insurance markets. After more than a decade of experience with reform, New Jersey policymakers are revisiting that state's regulatory regime. New Jersey's regulators and insurance carriers have been particularly receptive to scrutiny of that state's efforts to encourage affordable access to individual health insurance. Shortly after implementing its major reforms in 1993, and again in 2002, state officials and participating insurance carriers made themselves and their data available to academic researchers. As well, stimulated by their interest in improving the effectiveness of regulation in the individual and small-group markets, New Jersey regulators eagerly collaborated with researchers at the Rutgers University Center for State Health Policy in 2003 to convene the experts represented in this volume to help them understand the impact of insurance market reform across the states. This close collaboration between policy researchers and regulators and insurers provides an essential platform for assuring the relevance of researchers' efforts and the effective translation of their findings into policy and practices.

The goal of this collection of essays on state insurance market reform is to fill an important gap in our knowledge. Through the efforts of a group of nationally recognized health economists and individuals with unique expertise in the provision, regulation, and impact of private health insurance, we have assembled a broad and diverse set of essays that will help to put the research findings in perspective and that will enlighten readers as to the critical methodological requirements necessary to identify a causal relationship between reform and outcomes of interest. It is our hope that these contributions will also serve to illuminate the sometimes contentious debate over the impact of reform, provide insights which will be of value to both researchers and policymakers alike, stimulate consideration of ways to improve reform's performance, and raise possible policy responses to the shortcomings of reform. Above all, we hope that this volume will contribute to a dialogue between researchers and policymakers as to ways to address the equity and efficiency implications of disparities health insurance coverage among the US population and the appropriate balance between regulatory efforts and private market activity in helping to address this important welfare issue.

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