This article is a detailed guide on how to apply for medical insurance. The pros and cons of medical insurance and the plan that is suitable for you
Life always comes with unexpected events that deeply affect our lives. One of those unexpected events is medical emergencies that affect the well-being of a person. Medical emergencies include accidents, chronic diseases, and other types of diseases that can stress a person out. In these situations, there is always a need for a plan that can save you. Furthermore, the increase in inflation has also increased medical expenses. The cost of health checkups is too expensive to cover with one’s own savings.
Health is something that should not be compromised upon. This is why getting medical insurance is not an option but a need. It is a must-have for you and your family. In many countries, there is a strict law that instructs citizens to get insurance at all costs. If not taken seriously, people have to pay a fine for it.
If you do not have medical insurance, then you will forever be in a dilemma of paying high-cost treatments with no savings in your account. In today’s world, you should know how to apply for medical insurance based on your medical eligibility so you can save up for the future.
Based on the data collected by HHS, in 2021 approx. 31 million citizens have medical coverage through the Affordable Care Act.
Medical Insurance is one of the most important parts of living in the modern world. It is a complete package that covers your health expenses and gives assurance about your health. Here is a complete guide on how to apply for medical insurance:
Table of Contents
- 1 What is Insurance?
- 2 What is Medical Insurance?
- 3 How does Medical Insurance Work?
- 4 What does Medical Insurance cover?
- 5 Types of Medical Insurance Plans you can apply for
- 6 What Medical Insurance plan suits you?
- 7 How to Apply for Medical Insurance?
- 8 Income Limits 2021
- 9 Bonus: Medical Insurance Keywords that you should know
- 10 Conclusion
What is Insurance?
Firstly, you need to know the exact meaning of insurance. Insurance is basically a package, a contract that you sign that states the government’s policy to protect you from any financial loss regarding that specific sector.
In simple words, insurance is a way of covering up any damages or expensive recovery by paying less. Insurance covers up most of the cost of the damage.
What is Medical Insurance?
Medical insurance, also known as health insurance, is a financial package that covers your medical expenses. If you are suffering from a chronic disease, or have to go through surgery, medical insurance covers most of the cost of the process.
Medical insurance plans include covering prescribed medicines, dental costs, etc. Every medical package comes with different plans that cover up the expenses based on it. Therefore, it is important for you to know how to apply for medical insurance.
How does Medical Insurance Work?
Medical insurance is a very complex procedure but the comfort it brings is nothing compared to that. Many insurance companies offer good plans that can work well for people. Among that premium package plans you need to know how to apply for medical that suits you best.
Medical Insurance companies offer plans that require you to receive medical treatments from designated hospitals or clinics under the plan. If you receive treatment from another medical institution that is different from the designated one, the companies might refuse to cover up the expenses. But that also depends on each case.
In many plans, insurance can cover up prescription drug expenses if it falls under a brand that is stated in the plan. Medical insurance plans have rules stated on the contract that you sign, therefore, it is important to sign after reading all the policies that can benefit you.
What does Medical Insurance cover?
A medical insurance plan is well-designed based on the government’s required policies and the company’s own rules that the person must follow. Apply for medical insurance that is best for you.
Before that, you need to know what a medical insurance plan covers:
- Outpatient Care: Outpatient care consists of all the check-ups that you might take on a monthly basis or every six months. This can also include all the plans that do not require any overnight observation from the hospital.
- Maternal Care: If you have a family, it is important that they fulfill the treatment of maternal care. Babies and mothers require frequent check-ups, medical insurance covers these expenses for you.
- Mental Health: Mental health is as important as physical health. Many medical insurance plans cover mental health treatment expenses. This is because it is part of the medical benefit based on the health ministries.
- Prescribed Medicines: A doctor may prescribe some medicines or antibiotics which can be bought under the health insurance plan. You can only buy certain drugs that are mentioned in the plan. If you get treatment from a hospital that is in the insurance plan network, then the doctor is most likely to prescribe drugs that the plan covers.
- Laboratory Tests: If you require lab tests, the insurance plans also cover the expenses of these tests. This also includes x-rays or MRI scans.
- Emergency Treatment: If you meet an accident, or injure yourself in some way that requires emergency treatment, the medical insurance plan covers the cost.
But before applying, you should know the types of medical insurance plans so you can pick and choose one that suits you and your family.
Types of Medical Insurance Plans you can apply for
Medical insurance plans have different categories. If you go to an insurance company, they will start listing down these plans that make you feel overwhelmed with too much information. Signing for insurance.
Before visiting the insurance company, you need to have some basic knowledge about the types of medical insurance plans that are shown to you. And which one you should pick for yourself.
By knowing the different types of medical plans, you can have the confidence to talk and point out some clauses that might confuse you. An agent will try their best to get the best insurance for you, but you still need to be aware of the plans yourself as well. Furthermore, applying online can also confuse people a lot. Once you know these types, you can choose one without wasting any time.
So, here are types of medical insurance plans:
High-deductible health plans (HDHP)
HDHP is one of the most popular medical plans these days that many people buy. This plan has a lower premium cost and high deductible as compared to normal packages. This type can be your best choice to apply for medical insurance plan.
HDHP covers the expenses once you pay a certain deductible out of your own pocket. This plan is really good for people who can pay deductibles easily. According to a report by the IRS, in 2021 the most suitable medical plan is that covers deductibles of at least $2,800 for a family. For individuals, it should be at least $1,400.
This medical plan has some advantages and disadvantages:
- Tax-free: If you choose HDHP for yourself, you save yourself from paying high taxes. Many insurance companies offer plans that are approved by governments so the tax becomes deductible. Some even give the benefit of not paying the tax at all. This is possible if you have a health savings account.
- Cheap premium: The plan offers you a cheap premium that you have to pay on a monthly basis. This ensures that you have enough expenses that you can save up and be within the budget. HDHP is a suitable plan to save up for future expenses.
- Pay from your pocket: If the medical treatment exceeds the maximum deductible then you have to pay the extra expenses with your money. You first have to pay it yourself, then only the insurance plan pays the remaining cost that is limited to the deductibles. This depends on which medical institution you are getting treatment from. If you receive treatment from the hospital that the insurance company is a partner of, then there might be exceptions.
Health Maintenance Organizations (HMOs)
Health maintenance organizations are a network of medical institutions and staff that treat you, abide by an insurance plan contract. There are a variety of facilities that you can choose from but it is limited to only certain networks. However, in case of emergency services, they can cover the expenses that are out-of-network. It depends on which plan you apply for medical insurance.
Furthermore, there is a primary physician under contract with you to whom you can go for check-ups. If you require a complicated surgery or advanced treatment, it must first be approved by the primary physician.
If you are receiving treatment from a hospital that is not mentioned in the list, then the expenses will not be covered. require you to pay on a monthly basis or annually. An HMO can be a private or a public insurance company, both have specifications that you can decide suit you better.
- Low Cost: This insurance plan is low cost as it covers lower prices. This means that the premium, as well as the amount you pay out of pocket, is less. This is beneficial for those who earn less or are healthy enough to not require serious treatments
- Primary Physician: In the HMOs, you have a primary physician under contract. They can be your advocate for receiving advanced treatment if needed.
- Limited Network: As mentioned before, this type of insurance plan only has a limited network of physicians that are under contract with HMO. So, your choice also becomes limited to a few physicians that might suit you.
- Limited Emergency cost: Even if the insurance plan states that it would cover emergency services, there are still some conditions that you must meet. If those conditions are not covered then you have to pay the cost yourself.
Exclusive Provider Organizations (EPOs)
Exclusive provider organizations are networks of physicians and hospitals that are under contract. If a person signs a contract with EPOs, they cannot receive treatment outside the provided facilities. This insurance plan is suitable for people who do not require frequent checkups. This also depends on the policies that the insurance plan offers to you. You should apply for medical insurance that suits you.
EPOs are limited to certain facilities but provide the best treatment available. They cover all the medical benefits that one requires.
- Low Cost: EPOs is.a low-cost insurance plan that is collected on a monthly or annual basis.
- Access to In-network: As long as you are going to the EPOs network, you have the freedom to choose whoever you want to get treatment from.
- Non-network cost: If you go to a facility that does not fall under the EPOs network, then you will not get any expenses covered. In other words, you have to pay it in your own pocket.
HMO vs. EPO
HMO and EPO insurance plans might look the same to you, but they aren’t the same. You need to know the difference between both plans before you apply for medical insurance.
HMO requires you to have a primary physician write you a referral note in order to get treatment from another doctor. For example, if you want to go for a dental checkup, then you need to visit the primary doctor first. The primary doctor will write you a referral note that you can show to the dentists so that your expenses are covered by the insurance plan.
Whereas in EPO you can visit anyone without a referral code as long as it is within the network. The policy is listed in the EPO insurance plan. There is a list of healthcare facilities that you can visit.
Point of Service Plan (POS)
Point of Service Plan is the combined version of EPOs and HMOs insurance plan. It requires you to visit only the primary care doctor. If you need a different treatment, your primary doctor has to sign a referral note that you can use for the insurance plan to cover.
Not many people sign this insurance plan as it is limited but because of its less cost, it can be considered a good plan. An example can be, if you visit your primary doctor, the insurance will pay 80% of the expense. But if you go to an out-of-network doctor, it will only cover 70% only if you have a referral note from the primary doctor. This plan depends on your medical eligibility.
- Low Cost: This insurance plan has a lower cost compared to other plans. You can easily buy this insurance plan if you have less pay.
- Limited hospital facilities: POS is only limited to a network of doctors or hospitals where you can go. If you visit a hospital that is not included in the list, then the insurance will cover less for your expenses.
What Medical Insurance plan suits you?
Medical insurance plans have many different plans that are arranged in premium and normal packages depending on the amount a person can pay on a timely basis.
Medical insurance plans differ in terms of treatments and prescriptions. If you are a healthy person, choosing a basic medical plan is best for you that covers up the requirement. How to apply for a medical plan that is best for you is based on your situation and budget.
If you are in Good Health: If you have no chronic disease or any serious medical complications, then choosing a simple insurance plan is best for you. Apply for medical insurance that requires less premium but offers good health facilities. You can get a medical checkup every 6 months, or when needed at a low cost.
Furthermore, in case of emergencies, you can rest assured that you have an insurance plan to cover the expenses.
If you have a chronic disease: Most middle-aged people suffer from chronic diseases that require them to get monthly check-ups. In that case, the insurance plan offers good hospital facilities and less out-of-pocket costs. You need regular check-ups and prescriptions, which a normal insurance plan might not cover that much.
Apply for a medical insurance plan that gives you the advantage of an affordable premium with more options in terms of medical benefits.
In case of emergency: As mentioned before, emergency expenses are covered by almost all insurance plans. So, whether you apply for EPOs or HMOs, emergency services will be covered by all.
In case a person has a disability, is of old age, or is in any kind of critical condition, there are separate insurance plans for them.
How to Apply for Medical Insurance?
Now that you are aware of all the inclusions and complications in a medical insurance plan, you should know how to apply for it.
Here are some ways on how you can apply for a medical insurance plan:
Contact an Agent or Broker
An agent is the best person to refer to for a medical insurance plan. They have the right expertise and experience to find you the best plan and help you in clarifying any complicated procedures regarding the insurance plan.
There are brokers as well who work for many organizations and provide you with the one that covers your requirements well. These brokers and agents take a commission as well for their services to you but you can rest assured knowing you will get the best plan.
You can also apply online through the official websites of insurance companies. This is only possible if you know some of the best insurance companies or have found the right one that suits your requirement best. You can fill an application online with all the requirements and paperwork.
As you are applying online, you need to provide scanned files for the required documents. You simply fill in all the blanks including your name, address, occupation, source of income, number of dependents, social security number, tax filing status, etc. all of this varies depending on whether you are getting individual insurance or family insurance.
The online website, then, shows you different plans that they offer from which you can choose according to your preferences. Most of the insurance plan websites categorize plans as Bronze, Silver, Gold, and Platinum. These four tiers are arranged from least costly to expensive on premium with different medical benefits.
You can apply at Medi-cal or at Covered California, online as well based on the eligibility.
Income Limits 2021
As the income limit differs on a yearly basis, it is important to know your medical eligibility before you apply for medical insurance.
According to the Department of Health California, medical income limits in 2021 are determined on a yearly basis. The citizens have to fall under the limit in order to be eligible to apply for medical insurance.
Medi-cal Income Limits 2021: Medi-cal Eligibility
If an individual is earning income less than or equal to 138% of FPL, they are given Medi-cal eligibility. For household income, it should be equal to or less than 266% of FPL they can apply for Medi-cal.
The single adult should earn an adequate amount in order to be considered for the Medi-cal eligibility.
Covered California Medical Eligibility
If the person or family is signed for a Covered California medical insurance plan, the contract will be considered if they fall under the FPL 2020.
You can determine the FPLs based on your income and whether you will newly sign or previously sign with Covered California.
Bonus: Medical Insurance Keywords that you should know
Medical insurance consists of some keywords that are used in the contract very often. When you apply for medical insurance, you should be aware of these terms.
- Premium: Premium means the amount that you have to pay on a monthly basis to the insurance company. Even if you rarely go for a checkup, you still need to pay the amount.
- Co-pay: Once you are subscribed to a medical insurance plan, you will get a discount for check-ups. If you go for a medical checkup, some percentage of the amount is covered by insurance while you pay less. This is co-pay.
- Deductible: The amount of money that you have to pay for your medical expense before the insurance plan pays. If you spend enough money on medical expenses to reach the deductible, then the insurance plan will cover it.
- Co-Insurance: After you have fulfilled the deductible, then the percentage of the medical bill you have to pay is called co-insurance.
- Out-of-Pocket Maximum: It is the cost limit given on the insurance plan that you pay in a year. If you meet the required limit, then the insurance plan covers 100% of your medical bill for the remaining year.
Now that you have read the article, you know how to apply for medical insurance and where to apply. You also know about Medi-cal eligibility and Covered California medical insurance through this article so you have the confidence to subscribe to an insurance plan for you and your family.
A medical insurance plan is prone to be beneficial given that it provides so many facilities. There are times when you might be short of money or cannot afford treatment expenses in one go. Insurance plans exist to bring comfort to you and plan for the future. Apply for a medical insurance plan today but make sure that you do your research and choose the best plan for yourself.