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One of the keys to finding affordable health insurance is educating
yourself enough to make choices between different insurance products
and to understand the process of buying individual health
insurance.
Difference between individual and group health insurance.
Group health insurance is offered to employers and groups (unions,
trade and professional associations).
The reason why group insurance is much more affordable to buy
owes to the fact that insurance companies do not require the evidence
of insurability. The risk they take is spread among members with
both good and bad health. When trying to buy an individual health
insurance, it is usually required to undergo some kind of medical
exam that provides the evidence of insurability. Insurance companies
routinely deny coverage to individuals with what they consider
to be risk factors, some of which are not entirely based on one’s
medical history. It could just as well be a habit, age,income
etc.
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Health insurance through HMOs and PPOs.
There are two major kinds of health insurance:
- Health Maintenance Organization (HMO) – a member pays
a flat monthly fee, and the HMO provides health services when
they are needed.
- Preferred Provider Organization (PPO) – the health
insurance company has contracts with health care providers like
doctors and hospitals, and they provide services.
With HMOs you are assigned to a doctor you choose, often called
the primary care physician, and he, along with the medical group,
make decisions regarding the treatment that the HMO insurance
will pay for. Primary care physicians must usually authorize any
services provided by a specialist, in order to be covered by insurance.
PPOs usually have large networks of doctors, and you can visit
any of them at any time. Depending on a particular program, the
insurance company will pay a percentage of medical bills after
the deductible has been met.
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