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The United States does not have socialized medical care. If you do not have health insurance, you need to pay for the health of your own finances? N at the time of service. This may be done in many thousands of dollars for serious diseases. You buy health insurance for the same reason you buy other types of insurance to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that can be very expensive. You can not predict what your medical bills will be. In a good year, your costs low. But if you become ill, your bills are very high. If you have medical insurance, many of your costs covered by third payer, not by you. A third payer is an insurance company or, in some cases your employer. Many people in the United States are enrolled in some kind of managed care health insurance plan. This is an organized way of both providing services and paying for them. Various forms of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans and fee-for-service plans. Persons enrolled in health plans pay a monthly or quarterly compensation insurance for the time they need medical attention. At the time a service is provided, the organization pays the health insurance some or all of the fee, to minimize the amount you must pay when you receive the service. The information presented here will help you choose a health insurance plan that is right for you. If you are married or single, have children or no children, this information will help you figure out how a health insurance plan that best meets your needs and your finances? Le situation choose. Definitions of health insurance terms used are included in the section called Understanding Health Insurance Terms. Understanding Health Insurance Terms Co-insurance The amount you needed to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurer pays 80 percent of the claim, you pay 20 percent. Co? Of BenefitsA ordination to avoid duplication of benefits when covered by more than one group plan to take away. Benefits under the two plans are usually limited to no more than 100 percent of the claim. Co-payment Another way of sharing medical costs. You pay a fixed amount each time a medical service (for example, $ 5 for each visit to the doctor). The insurer pays the rest. Covered ExpensesMost health insurance plans, whether they are fee-for-service, HMOs, or PPOs, do not pay for all services. Some people can not pay for prescription drugs. Others may not pay for mental health. Covered services are those medical procedures the insurer agrees to pay for. They are included in the insurance policy. Usual FeeMost health insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your doctor charges $ 1,000 for a hernia repair while most doctors in your area charge only $ 600, you’ll be billed for the $ 400 difference. This is in addition to the deductible and coinsurance you would expect to pay. To avoid this additional cost, ask your doctor for your health insurance payment as payment in full to accept. Or shop around to find a doctor who will. Otherwise, you will have to pay the rest. DeductibleThe amount of money you need each year to pay for your medical care expenses to cover your health insurance policy begins to pay. ExclusionsSpecific conditions or circumstances on which the policy does not benefit. HMO (Health Maintenance Organization) Prepaid health plans. You pay a monthly premium and the HMO covers your doctor visits, hospital stays, emergency care, surgery, monitoring, laboratory tests, x-rays, and therapy. You must use the doctors and hospitals by the HMO. Managed Care Ways to reduce costs, use, manage and quality of healthcare. All HMOs and PPOs, and many fee-for-service plans, managed care. Maximum Out-of-pocket ExpensesThe most money you will pay per year for deductible and coinsurance. It is a stated dollar amount that the insurer, in addition to regular premiums. Non-cancellable PolicyA policy that guarantees the health insurance as long as you pay the premium received. It is also called a guaranteed renewable policy. PPO (Preferred Provider Organization) A combination of traditional fee-for-service and an HMO. When the doctors and hospitals that are part of the PPO, you can use a larger portion of your medical bills covered. You can use other doctors, but at higher costs. Pre-existing health problem that existed ConditionA v? R the date your insurance became effective. PremiumThe amount you or your employer pays in exchange for health insurance coverage. Primary Care DoctorUsually your first contact for healthcare. This is often a general practitioner or internist, but some women use their gynecologist. A primary care doctor monitors your health and diagnoses and treats minor health problems, and refers you to specialists if another level of care needed. Many health insurance plans, care by specialists is only paid for when you are referred by your GP. An HMO or a POS plan will give you a list of doctors from which your primary care doctor (usually a general practitioner, internist to choose midwife-obstetrician, or pedicatrician). This may mean that you might have to choose a new doctor if your current does not belong to the plan. PPOs allow members to primary care physicians use outside the PPO network (at higher costs). Indemnity plans a doctor to be used. ProviderAny person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care. Third-party payer PayerAny healthcare services other than you. This may be an insurance company, an HMO, a PPO or the federal government