If you are one of the many individuals who are not covered by group health insurance through your employer or other organization, you will need to go out into the market and research individual health insurance plans. Individual health insurance plans essentially come in two “cbdrumourcom“: Indemnity (fee-for-service) and managed care plans (HMO, PPO, POS). In general terms, the major differences lie in the choice of healthcare providers, out-of-pocket expenses, and how the bills are paid.
Even though the health insurance market has seen a dramatic shift away from indemnity plans (due to higher costs), these plans are still often referred to as the more traditional form of health insurance since they have been around the longest.
For indemnity health plans, individuals typically pay a predetermined percentage of medical care costs (called co-insurance) and the insurance company pays the balance. A common indemnity plan is an 80/20 plan, where the insurance company pays 80% and you, the insured, pay 20%. Your insurance company will only make payment in accordance with the “usual, customary, and reasonable” (UCR) fees as determined, which are based on what health care providers charge in your area for a given service. Of course, if your individual health insurance plan has a deductible, this must be met first before this pay structure kicks in.
Depending on your indemnity health plan, you may be required to pay for services upfront and submit claims for reimbursement directly from the insurance company, as opposed to your provider directly billing your insurance company for services.
While an indemnity individual health plan allows you much freedom in terms of provider and medical facility choice, this freedom does not come cheap. The cost can vary as to how much of a deductible you have and your out-of-pocket limit. As you might expect, as your out-of-pocket expenses increase (deductibles, co-pays, co-insurance), the cost of your health care premiums go down. Even so, this is one of the more expensive types of individual health insurance plans out there.
Additional individual health insurance plans are managed health care plans, like HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and POS (Point of Service) plans.
