Health Care
Choosing a Health Plan
With the countless options available and the complex terminology and paperwork, selecting a health care plan can be overwhelming. There are two basic types of plans: group plans (plans supported by an employer) and individual plans (plans not supported by an employer). Whether you have access to a plan supported by an employer or you need an individual plan, these tips for selecting a plan can help.
Before choosing a plan, ask yourself:
- How much can you afford to pay monthly for health care?
- Who requires coverage under your plan (just you, and a spouse or dependents as well)?
- How often do you, your spouse, and children visit the doctor?
- Do you want or need dental and vision coverage?
- Do you or your dependents have medical conditions that require specialized care?
- What would happen in the event of an accident or surgery?
- What is the maximum deductible you could afford to pay?
Knowing the answers to these questions can help you understand your health care needs and financial considerations. If you or a family member has a pre-existing health condition, it can be more difficult to get the health coverage you need. As part of the Affordable Care Plan passed in 2010, there is a Pre-Existing Condition Insurance Plan (PCIP) available. You can find out more about it here.
Managed Care Health Plans
Here is a brief explanation of some of the most common Managed Care health plans:
- HMOS (Health Maintenance Organizations) are a type of health insurance plan where coverage is limited to doctors who work for or contract with the HMO. A primary care physician generally oversees your care and must refer you to specialists as needed.
- PPOs (Preferred Provider Networks) allow subscribers to use doctors, hospitals and providers outside of the network for a fee.
- High-Deductible Health Care Plans are high-deductible plans with low monthly premiums, designed to offer minimal day-to-day coverage but to protect you in the event of a catastrophe.
- Point of Service Plans combine some aspects of PPOs and HMOs. Like PPOs, they generally require users to choose a primary care physician, who can make referrals to other doctors inside or outside of the network.
- Fee-for-Service Plans reimburse you for a large percentage of what you pay out of pocket. You pay the bill for services; then your insurance company pays you back.
After choosing your plan and services, make sure to use them wisely. Most health insurers supply educational materials on preventive care such as quitting smoking, weight loss and chronic disease management.
Staying Physically and Fiscally Healthy
In addition to making life more enjoyable, living a healthy lifestyle is key to keeping healthcare costs down. Being fit can help save on health insurance - many companies factor in height and weight when determining rates for consumers. Making healthy choices, like quitting smoking, can also help to keep your health care and medical insurance costs done.
Health Savings Accounts (HSAs)
Health Savings Accounts (HSAs) are tax-free savings plans Floridians can take advantage of to pay for qualified medical expenses. This program allows you to deposit pre-tax dollars into an HSA up to the level of your deductible plan and must be used in conjunction with a high-deductible health plan. To qualify, the health plan must have a minimum deductible of $1,400 in 2021 for an individual policy and $2,800 for a family policy. The insurance premium is paid for in addition to the HSA. Nothing in the ACA will infringe upon the ability of an individual to contribute to a Health Savings Account (HSA) or discourage an individual from doing so.
Learn about more about HSAs - Health Insurance and Health Maintenance Organizations
Appeal The process of requesting a provider or health plan pay for a service for which payment has been denied.
Auto-Enrollment The automatic assignment of a person to a health insurance plan.
Broker A salesperson that has obtained a state license to sell and service health plan and insurer contracts.
Claim A request by an individual that his or her insurance company pay for medical services received.
COBRA Federally supported health care benefits for people whose employment has been terminated, or who have experienced other circumstances that lead to loss of coverage.
Copayment The set amount of money a health plan enrollee pays for a specific service.
Deductible The minimum amount of out-of-pocket expenses a health care plan enrollee must pay for medical services or medication before their plan begins to cover expenses.
Employee Assistance Program (EAP) Benefits that are designed for personal or family problems, including mental health, substance abuse and other problems.
Enrollee A subscriber or dependent that is eligible for coverage under a certain health care contract.
Exclusions Conditions or situations not covered under a certain contract or plan.
Fee-For-Service (FFS) A traditional method of payment for health care services where users pay for services rendered.
Flexible Spending Account (FSA) A plan that provides employees with the opportunity to set aside funds pre-tax for certain medical expenses.
Group Health Plan Health coverage to employees and their families, provided by an employer or employee organization.
Health Maintenance Organization (HMO) A type of U.S. health care coverage where subscribers are required to receive all of their health care from a provider within a given network.
Health and Human Services (HHS) The U.S. department that is responsible for health-related programs and issues.
Health Care Provider Providers of medical or health care.
Individual Plans A type of insurance plan for individuals and families not eligible for health care coverage through an employer.
Lifetime Limit A cap on the benefits available during a subscriber's lifetime under a given policy.
Managed Care Systems and techniques used to manage health care services.
Medicaid A federal and state program that helps with medical costs for some low-income individuals and families.
Medicare A federal program that helps cover the medical costs of elderly and disabled individuals.
Open Enrollment Period A period during which subscribers in a health program can revise their benefits.
Patient Assistance Programs Programs offered by pharmaceutical companies to provide free or low-cost medications to people who could not otherwise afford them.
Pre-Existing Condition A condition or illness that you have before enrolling in a health care plan.
Preferred Provider Organization (PPO) A type of health care plan where a group of doctors and hospitals agrees to render particular services to a group of people for a reduced cost. This type of insurance is generally more expensive than HMOs but offers subscribers more freedom to select physicians.
Premium The amount paid to a health care company for providing medical coverage under a contract.
Preventive Care Health care that emphasizes prevention, early detection and early treatment.
Primary Care Physician (PCP) A "generalist" physician who, under certain health care plans, is accountable for the total health services of enrollees.
Referral The process of referring a patient to another doctor for specific health care services.
State Health Insurance Assistance Program (SHIP) A state-run, federally funded program that provides free local health insurance counseling to Medicare subscribers.
Waiting Period The minimum amount of time an individual must wait before becoming eligible for specific benefits after coverage has begun.
Workers' Compensation Insurance that covers employees who get sick or injured on the job.
Health Care Resources
Many people struggle to pay for health care and prescriptions. If you have difficulty affording needed services and medications, there are many available resources that can provide significant relief. Here are a few of the most common resources available.