Photo by National Cancer Institute on Unsplash

By Linda Williams

A comprehensive health insurance plan covers a wide range of healthcare needs for the policyholder. It covers outpatient care, inpatient care, consultations, and all the medical tests required during treatment. Some policies also cover the costs of medications the policyholder depends on for recovery. Comprehensive health insurance varies significantly between providers. Some plans cover preventive care, while others only include the most basic healthcare needs.

The ACA requirements

The aim of the Affordable Care Act (ACA) is to ensure that comprehensive health insurance is available to all Americans. It requires all major medical policies issued after 2014 to cover a minimum of ten essential health benefits (EHBs) without imposing annual caps. The benefits include emergency services, hospitalization, ambulatory patient services, mental health, substance abuse, and pediatric care. The reforms have ensured that you can find affordable health insurance in your state.

Co-payment and deductibles

Most comprehensive health policies require the holder to make copayments or pay deductibles. This is a shared cost plan where the insurance provider commits to cover a certain percentage of the healthcare costs. Some policies cover 100% of all the expenses left after paying deductibles, while others cover 50 or 75% of the costs.

Copayments are stipulations in the policy requiring the holder to make out-of-pocket payments for services such as lab tests and prescription refills. The policyholder pays a specific percentage while the insurer pays the rest. Typically, policies with high monthly premiums have lower copay amounts than those with low premiums.

Unlike copayments that apply when the policyholder seeks medical treatment, deductibles apply on an annual basis. For instance, a policy requiring the holder to pay $2,000 in yearly deductibles means that the insurer will only cover the charges that exceed the set amount.

Managed care

Managed care is a comprehensive insurance arrangement where the provider vows to manage the holder’s healthcare needs. The three types of managed care plans are:

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Point of service plans (POSs)

HMO plans limit their coverage to physicians who are contracted by the HMO organization. They don’t cover out-of-network services unless it is an emergency. On the other hand, PPOs are insurance providers who have contracts with a network of healthcare providers, such that policyholders pay less if they use their services.

PPOs provide more comprehensive services than HMOs. POSs are insurance policies where holders pay less if they use healthcare facilities affiliated with the network. With these plans, members can only visit a specialist once referred by a primary care physician.

Traditional health insurance

Traditional policies are health insurance plans that existed before the ratification of the Affordable Care Act. In this plan, policyholders reserve the discretion to choose the providers and physicians who treat them. Most traditional health insurance includes co-insurance, deductibles, and ordinary premium plans. The scope of coverage varies depending on the provider.

Group policies

Most insurers provide group policies that cover entire families or categories. Typically, group policies cost less than individual policies. In fact, policies covering groups such as employees or church members cost much less than individual plans.

Difference between comprehensive and limited policies

Limited-benefit plans are policies that cover specific health conditions or situations. For instance, a limited policy covering accidents will only apply when the holder is involved in an accident. By contrast, a comprehensive plan covering emergencies will pay for expenses related to accidents and any other emergency that requires medical attention.

However, the difference is most profound when the holders of either type of policy are diagnosed with a chronic illness requiring long-term hospitalization. The comprehensive plan provider may pay hundreds of thousands in medical expenses, while the limited policy provider may only agree to pay tens of thousands. Suppose you or a dependent must spend several weeks to several months under a healthcare team’s supervision. In that case, you risk declaring bankruptcy to cover said expenses if you initially opt for a limited-benefit plan.

Policy options

The insurance provider may present a policyholder with different options applicable to specific client groups such as married couples and people living in remote locations. Optional plans often increase the monthly premium payments but enhance the benefits of comprehensive insurance.

For instance, individuals living in remote locations may take the medical evacuation option while young couples can capitalize on prenatal and postnatal care opportunities.

Why you should have comprehensive health insurance

Health insurance is an investment that will come to your aid when you desperately need health care. It will ensure that you receive the care you need without incurring a hefty load of costly medical bills. It’s important to note that cost varies according to state and the type of coverage you request. To set reasonable price expectations, conduct a quick online search for more information on your state costs.

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