Family Health Insurance Plans and Their Differences

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Having health insurance that suits your personal and family context is essential. As a preventive planning tool, I think that it is better to invest in a tool that keeps you protected, even if you don’t use it, than when the time comes when you really need it and don’t have it.

The number one question we get from readers is, “Do you have family health insurance?” There are many reasons why people would like to have family health insurance. If you’re married, you might have a spouse with a health condition that could potentially make it difficult for you to both stay healthy and take good care of him or her. If you are single, you’re likely to find it difficult to cover all those bills, so family health insurance might be something that you might want to consider.

For this reason, it is very important to choose the plan that is best for you and your family, especially if your job does not offer group health insurance, or if insurance is very limited.

What is family insurance?

In the United States, most medical care is carried out thanks to medical insurance, which can be individual or family. The family insurance policy works because its owner pays an agreed amount to a health insurance company. In return, when medical care is needed, that company must pay its full cost or a portion of it. Most family health plans have three parts:

  • Benefits. That is, what the family insurance pays for: medical care, medicines and medical check-ups.
  • Costs. These affect what a family must pay as medical expenses; These costs include deductibles, copays, and premiums.
  • Networks. This is a group of health care providers (mainly hospitals and doctors) that are contracted to provide medical services at low cost as part of the health plan.

Why are there different types of insurance?

There are different types of insurance given the differences in contexts. For example: consider age, risk factors, congenital diseases, lifestyle, occupational risks, etc. as some of the factors. In addition to this, you will find varieties in types of coverage, insured amounts and specific characteristics of each company.

HMO Insurance: Health Maintenance Organization

These insurances start from a company that offers a network of private services that include both medical personnel and hospitals.

What you should know: Take into account that the costs are accessible and they have preventive and corrective care. It is necessary that you live in an area where they have these services in order to be insured.

PPO Insurance: Preferred Provider Organization

It is the network of professionals and hospitals that offer discounts and from which you can choose the service that best suits your requirements.

What you should know: If for any reason you want care from a specialist who is not affiliated, there is an option to pay an extra fee without prior evaluations.

POS Insurance: Point of Service Plan

It is a network of services and providers that needs an evaluation by a general practitioner before seeing your specialist.

What you should know: It also allows you to choose doctors and other outside services at a higher cost.

EPO Insurance: Exclusive Provider Organization Plan

It is the type of insurance that offers medical and hospital care within the available service network.

What you should know: It is the strictest and you will not be able to count on care from your primary care doctor if you are not affiliated with this network. Please consult this in advance if it is particularly important for you to keep your visits with your doctor.

When the time comes to contract your insurance, we recommend that you do not contract the first option you see, on the contrary, review all the options on the market, since these options are usually granted by the different insurers depending on the cost of the policy in a classification named: Platinum, Gold, Silver and Bronze.

Special insurance

The government offers special programs focused primarily on vulnerable groups with limited resources.

Government insurance plans are aimed at:

  • Adults over 65 years.
  • Anyone who does not have or cannot afford health insurance.
  • Minors up to 19 years of age whose families have an income of up to US$44,700 per year.
  • Pregnant women

Options for help in cases of doubt or abuse

If you feel that your rights are being violated or that your insurance is not complying with the provisions of the contract, you can contact the National Association of Insurance Commissioners in your state. At the same time, we recommend that you look for the Consumer Protection services offered by the government.

Tips before taking out family health insurance

Compare carefully before buying

Policies vary in coverage and cost. We recommend making a table where you can compare the items that are most relevant to you. It is the simplest and most useful way to reach the best option.

Protect yourself with major medical expenses

Take care that your individual insurance policy protects you from major medical expenses. We know, the last plan one has for a Saturday night is to read the fine print of a policy. But if you ignore them, you will be adrift on a very important issue: the health of you and yours.

Review it and write down what seems confusing or doubtful and ask for this to be clarified, both by an insurance advisor and by the company that provides you with the policy.

Have a way out

Validate that the policy has a reconsideration clause. Most companies give you at least 10 days to review your policy after you receive it. If you decide it’s not the right policy, you can return it for a full refund.

Look at the details

Beware of policies that cover a single illness. There are some policies that offer protection only for one condition, such as cancer.

The rule of insurance is very simple: make sure you are very clear about what you are buying and what you are leaving on the table. If you are not sure of this information, do not act until you have all the information on the table.

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