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This guide briefly describes the different kinds of health
insurance plans available today, including:
- Non-network based coverage.
- Consumer-directed health plans.
You will find answers to many common questions
you may have about health insurance. Resources are provided
to help you find additional, more detailed information.
There is also a Glossary of health insurance
terms. Terms defined in the Glossary are in bold and linked the first time they appear in the guide.
Changes and Choices
Today, there are many more kinds of health insurance to choose
from than were available just a few years ago. Traditional
differences between and among plans may no longer apply. Also,
there is an increased emphasis on the role of consumers in
managing their own health care and health care finances. There
is a focus on providing information on the cost of care and
health care quality—at the level of the physician, physician
group, and hospital—to help consumers and employers choose
among the many options available to them.
A New Health Care Marketplace
Things have changed a lot since the 1970s, when most people
in the United States who had health insurance had indemnity
insurance. Indemnity insurance is often called fee-for-service or traditional health insurance. This type of coverage generally
assumes that the medical provider (usually a doctor or hospital)
will be paid a fee for each service provided to the patient—that
is, you or a family member covered under the policy.
With fee-for-service insurance, you go to the doctor of your
choice, and you submit a claim to the insurance company for
reimbursement. Often, your doctor or hospital will submit the
claim for you. You will only be reimbursed for "covered" medical
expenses; that is, the covered services listed in your plan's
When a service is covered under your policy, you can expect
to be reimbursed for some—but generally not all—of
the cost. How much you will receive depends on your policy's
coinsurance and deductibles. You will be responsible for the
portion of the bill not reimbursed by the insurance company.
Go to the section
on Indemnity Insurance for more information on coinsurance
Today, many Americans who have health insurance are enrolled
in a managed care plan, such as a health
maintenance organization (HMO) or a preferred
provider organization (PPO). For more
information on HMOs and PPOs, go to the section
on managed care.
When we talk about health insurance, we usually mean the
kind of insurance that pays medical bills, hospital bills,
and typically, prescription drug costs. This type of coverage
includes Medicare and Medicaid, two government programs that
provide health insurance coverage for certain populations,
such as seniors, people with disabilities, and individuals
and families with low income. But there are other types of
coverage as well, including disability
care insurance, and other coverage that can offer additional
financial protection for you and your family. Information on
these types of plans is provided later in this guide.
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