UNICARE health insurance provides individuals and families low rate coverage and comprehensive plans. Few of the UNICARE policies have low cost plans, with “$2,000” yearly deductibles for each family member, thus offering the maximum payout on claims. The plan may offer waivers on deductibles to family members that do not meet the limited doctor visits. In other words, the policy may stipulate that each family member is permitted two doctor visits in 12 months, and if the policyholder does not meet the limits then deductibles may be waived. The plans offer a “$30” Co-payment per member.
Be careful, since some plans charge 100 percent on three or more visits to the doctor. The plan may have low pricing with maximum deductibles of “$5000,” however, the doctor limits are increased. This means the higher the deductible the more visits you can spare, with waiver on deductibles and “$30” Co-payments. There may also be co-payments on prescription drugs, usually around $10 per prescription on generic brands.
It depends on the insurer but few offer low cost plans with higher deductibles and “tax deferred” bargains. The insurance provider may pay 100 percent of each visit to the doctor, which will include procedures, visits, hospital stay, outpatient care, and so forth. If the policyholder meets the deductibles then the company may pay the full price on prescription drugs generic brands.
If you are fall under the low-income guidelines, you may want to inquire about HMO PLANS. Rather, you may want to inquire about other types of HMO plans, since the UNICARE falls under the guidelines of low-income families.
HMO is an abbreviation of Health Maintenance Organization, and the plan is designed to meet the delivery of healthcare. The plan is constructed under a network, meaning that doctors, policyholders, and providers work together to provide coverage at lower cost to families and individuals. It is a managed health care plan that works within a network environment. This means that if you have an HMO plan then you are expected to get healthcare by the participants in the plan. In other words, the doctors have voluntarily agreed to charge less for medical care and have agreed to join the plan. If the doctor is not in the network then you may not be permitted to go out of the networking environment. If you need a specialist then you must ask your doctor for a referral, otherwise you cannot visit a specialist on your own without paying full price out of your own pocket. HMO is a Medicare program that is under rule of the “Federal Government,” following the “Medicare Advantage Program” rule.
At one time policyholders of HMO plans were permitted to go anywhere they choose to get medical treatment under the plan; however, the networking environment has increased restrictions and included exclusions under the plan. If you are in need of specialist care you may want to consider other types of managed care or insurance polices that do not have exclusions or works on a network environment.
If you apply for HMO and are accepted, you will also need to sign up for the “Medicare Part D” to receive coverage for prescriptions. There are two types of plans available, which include the HMO and PPO policies. Thus, if you do not apply for the “New Prescription Drug Benefit” you will need to cover your own medicine costs. Still, you will only get the generic brand with the HMO coverage plans. Furthermore, it depends on the plans, but few HMO plans with prescriptions have no premiums, while others may charge minimal premiums per policy. There are also deductibles in few of the HMO plans, including the D plan.
For more information regarding health insurance, it makes sense to go online and find all information as possible regarding premiums, rates, coverage and so forth. Online you can get several quotes to help you determine cost of health care services. Many insurance policies will include co-payments; however, Michigan is one of the states that offer HMO plans that do not have co-payments. Recently, Michigan HMO plans restored Chiropractic and Dental services to its plan; however, at one time there was no coverage for these services.
By: Michael Bens
Posts Tagged ‘Insurance Provider’
Health Insurance Covering Families in Michigan
February 4th, 2010What is Catastrophic Health Insurance Coverage?
October 30th, 2009
A major or catastrophic medical insurance plan, although being rather speculative, is fairly cheap but is also deductible. The money that you pay up from your own funds before the insurer meets the balance is the deductible.
As an example: if you have a deductible set at $5000 and your visit to a hospital results in a bill of $12, 000 your insurance provider will pay $7,000 only towards the bill and you meet the balance. On this type of cover, the larger your deductible is, the smaller the premium. By taking up this option, you will be gambling on not needing any major medical expense soon.
It would be a reasonable gamble. One survey that was conducted showed that in the US, 90% of the population has medical expenses less than $2000, and for 73%, their expenses were less than $500 per annum.
Two main groups favor the catastrophic health insurance: the young who are in their 20’s who feel their health is not at risk and elderly men between 50 and 65 who would be waiting on Medicare eligibility.
The catastrophic health insurance plan is designed to cover only against major hospital expenses rather than day-to-day medical expenses. It will not normally cover doctor’s visits, maternity care, or prescription drugs. The cover usually excludes mental health conditions, substance abuse and some pre-existing medical conditions.
This catastrophic health insurance plan can be bought as a group plan or on an individual basis. Of late, many organizations have started to encourage their employees to take up this type of cover. The highest lifetime limit can be as much as $3 million.
Rates do vary on age and the area in which you live. In some states the savings on premiums can be up to two-thirds. As an example: a female of 21 years, non-smoker, could have a monthly premium of only $30.
Before taking a decision to select this cover, get some professional advice from agents, insurance companies or both and compare quotes.
By: Jack Adams
Paying for Health Care – Health
October 29th, 2009
The cost of health care in the United States is expensive and is escalating. A majority of Americans cannot afford the cost of medicines, physicians’ fees, or hospitalization without some form of health insurance. Health insurance is a contract between an insurance company and an individual or group for the payment of medical care costs. After the individual or group pays a premium to an insurance company, the insurance company pays for part or all of the medical costs depending on the type of insurance and benefits provided. The type of insurance policy purchased greatly influences where you go for health care, who provides the health care, and what medical procedures can be performed. The three basic health insurance plans include a private, fee-for-service plan; a prepaid group plan; and a government-financed public plan.
Private Fee-For-Service Insurance Plan
Until recently, private, fee-for-service insurance was the principal form of health insurance coverage. In this plan an individual pays a monthly premium, usually through an employer, which ensures health care on a fee-far-service basis. On incurring medical costs, the patient files a claim to have a portion of these costs paid by the insurance company. There is usually a deductible, an amount paid by the patient before being eligible for benefits from the insurance company. For example, if your expenses are $1000, you may have to pay $200 before the insurance company will pay the other $800. Usually the lower the deductible, the higher the premiums will be. After the deductible is met the insurance provider pays a percentage of the remaining balance.
Typically there are fixed indemnity benefits, specified amounts that are paid for particular procedures. If your policy pays $500 for a tonsilectomy and the actual cost was $1000, you owe the health care provider $500. There are often exclusions, certain services that are not covered by the policy. Common examples include elective surgery, dental care, vision care, and coverage for preexisting illnesses and injuries. Some insurance plans provide options for adding dental and vision care. Other common options include life insurance, which pays a death benefit, and disability insurance, which pays for income lost because of the inability to work as a result of an illness or injury. The more options added to the insurance plan, the more expensive the insurance will be.
One strategy insurance companies are using to lower insurance premiums and out-of-pocket costs to the consumer is the formation of preferred providers organization (PPO). A PPO is a group of private practitioners who sell their services at reduced rates to insurance companies. When a patient chooses a provider that is in that company’s PPO, the insurance company pays a higher percentage of the fee. When a non-PPO provider is used, a much lower portion of the fee is paid.
A major advantage of a fee-for-service plan is that the patient has options in selecting health-care providers. Several disadvantages are that patients may not routinely receive comprehensive, preventive health care; health-care costs to the patient may be high if unexpected illnesses or injuries occur; and it may place heavy demands on time in keeping track of medical records, invoices, and insurance reimbursement forms.
Prepaid Group Insurance
In prepaid group insurance, health care is provided by a group of physicians organized into a health maintenance organization (HMO). HMOs are managed health-care plans that provide a full range of medical services for a prepaid amount of money. For a fixed monthly fee, usually paid through pay roll deductions by an employer, and often a small deductible, enrollees receive care from physicians, specialists, allied health professionals, and educators who are hired or contractually retained by the HMO. HMOs provide an advantage in that they provide comprehensive care including preventive care at a lower cost than private insurance over a long period of coverage. One drawback is that patients are limited in their choice of providers to those who belong to an HMO.
Government Insurance
In a government insurance plan the government at the federal, state, or local level pays for the health-care costs of elgible participants. Two prominent examples of this plan are Medicare and Medicaid. Medicare is financed by social security taxes and is designed to provide health care for individuals 65 years of age and older, the blind, the severely disabled, and those requiring certain treatments such as kidney dialysis. Medicaid is subsidized by federal and state taxes. It provides limited health care, generally for individuals who are eligible for benefits and assistance from two programs: Aid to Families with Dependent Children and Supplementary Security Income.
By: Robin Kumar Lim
