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Choosing the Right Medical Insurance for Your Family: A Comprehensive Guide

1. Introduction

Nothing is more remorseful than losing someone close to your heart just because of the cost of medical treatment that you could not afford at that time. Over time, the average life expectancy has decreased significantly due to increased diseases in the human body. The cost of any medical treatment can take a toll on your pocket. That is why you need a medical insurance plan for yourself and your loved ones.

In 2021, it has been seen that close to 27.5 million adults in the USA have not opted for a medical insurance. [1] Choosing a medical insurance policy that stands by your side in times of distress would be best. But in the sea of medical insurance providers, it becomes challenging to select the ideal one. There are myriad factors that you need to take into consideration before taking the final call. In this article, we will talk about several aspects of medical insurance, and along with that, we will also guide you in choosing the perfect medical insurance for your entire family.

2. Understanding Different Types of Medical Insurance Plans

To help you understand various medical insurance, we have enlisted a few of them with their own advantages and disadvantages.

  • Health Maintenance Organization (HMO) Plans

Health Maintenance Organization or HMO is an organisation that works with a group of physicians. Several physicians have a set contract with HMOs. If you invest in an HMO plan, you will receive medical care from the doctors associated with HMO at a discounted rate. Your health insurance will also cover the cost of your treatment beyond deductibles.

  • Point of Service Plans (POS)

The benefits of point-of-service plans vary depending on the policyholder’s choice of healthcare provider. In the point-of-service plans, features of both HMO and PPO plans get included. Based on whether you choose in-network services or out-of-network services, you will get the benefit from the insurance company. You will get the benefit of investing money in a POS plan across the nation. Although POS plans are cheaper than PPO plans, policyholders often need help understanding the plan’s details.

  • Preferred Provider Organisation Plans (PPO)

You, as the policyholder, will receive medical consultations, medicines, and healthcare at a lesser cost under an arrangement known as PPO. Private insurance companies usually offer PPO plans.

Besides that, depending on how many beneficiaries are there and the severity of the illness, you can avail of different types of health insurance such as critical illness insurance, senior citizens health insurance, individual health insurance, group health insurance, and others.

3. Identifying Your Family’s Medical Needs

Due to life’s uncertain nature, most people insure their health. Investing in health insurance has now become an integral part of yearly financial planning for a person. You need to keep some things in your head before choosing any medical insurance first and foremost, and you need to consider the medical needs of your own family.

The life you lead and your circumstances will be critical factors in determining what type of medical insurance you need.

It would be best if you always considered the benefits that you can get from medical insurance plans. Suppose you plan to have a baby soon or someone in your family develops a chronic illness. Under these circumstances, how the insurance plan of your choice will help decide whether it is worth your investment.

Last, you must also look at the plan details to know what kind of healthcare services you can get through your medical insurance plan. Moreover, your policy will also determine the medical services you will get as part of your insurance. So, choose wisely.

4. Evaluating Plan Features

The following are the key features that you should look for in your medical health insurance plan.

1. Amount of Deductibles

The deductible is a certain amount the insurer must pay to the policyholder after the medical expenses exceed a set limit. You must pay a predetermined limit mentioned in your medical insurance documents before the insurance company starts paying your hospital bills. Deductibles directly influence the premium amount. A high deductible means a policyholder must pay a lower premium and vice versa.

2. Check The Co-Pay Clause

Before the insurance company takes care of the charge of your healthcare services, you need to pay a certain amount known as a co-pay. It solely depends on the treatment you have received, the medical tests you have gone through, and the medicines.

Evaluating all the features of your medical insurance plan becomes essential as every family has different needs and a budget. You need to select medical health insurance that satisfies your family’s needs and in which you don’t feel that the insurance premiums feel like a burden to you.

3. Waiting Period

In case you are suffering from a pre-existing disease. The insurance company is not responsible for medical treatment for a certain period. This waiting period varies between 2 to 4 years. While choosing medical insurance, look for those having a short waiting period.

4. No Claim Bonus Amount

Suppose you have yet to claim money from the insurer for a financial year. In that case, the insurance company will cover your medical expenses the following year. This rewarding feature is known as a claim bonus. You should select a policy with the highest amount of no-claim compensation.

5. Premium That Needs To Be Paid

After a regular interval, you must pay a certain amount to the insurer to keep your medical insurance active. Compare all the medical insurance available and choose the one with the lowest premium amount that offers your family’s required benefits.

5. Assessing Plan Networks

Every existing medical insurance plan has an established network of medical professionals, pharmacies, and medical facilities. Depending on the medical services you choose or the doctor you choose to visit you will fall under a specific category based on which your insurance company will give you financial coverage for your treatment. There are two types of networks.

1. In Network

As previously mentioned, a medical insurance provider has a tie-up with doctors and medical service providers. These doctors will offer you medical treatment at a discounted rate, and your insurer will give you cover for your treatment charges. All the doctors, hospitals, and pharmacies in this category are considered in-network facilities.

2. Out of Network

Suppose the doctor or hospital you are visiting has no established connection with your medical insurance provider. In that case, you have to pay the entire bill for the treatment received. Your insurance provider will not pay for your treatment under these circumstances.

While choosing the medical insurance for your family, closely examine the insurance provider’s network. Some insurers have an extensive network, whereas others only offer you services in very few medical facilities. Select the medical insurance where you will get various service providers and can access an extensive network.

6. Comparing Plan Costs

As we have already discussed what you should look for in a health insurance plan, we hope you get familiar with the terms such as deductibles, co-payments, premiums, and others. Take your decision promptly. Take your time. Compare different plans and then decide which plan to select based on the things mentioned below.

Choose a plan with a premium amount you can afford after a specific interval. For an US citizen health insurance premium starts from 17 USD per month. [2]

Please select a plan with a higher deductible, as it will reduce your premium amount. But you can’t afford to pay a lump sum amount of money during your medical treatment as deductibles. In that case, you should choose medical insurance with a higher premium and lower deductible. Over the last decade the deductible amount has increased exponentially from 917 USD in the beginning of the last decade and now at present it has become 1763 USD. [3]

Co-payment that you must pay before your insurer steps into the field is considered significant. Make sure that the time you need to wait for your insurer is short and that the amount you need to pay is a manageable amount that takes a toll on your pocket.

7. Evaluating Additional Plan Benefits

There are numerous other benefits that you can get by investing in a medical insurance plan. Look for these additional benefits that come in handy in the long term.

  • Covering Pharmacy Bills

After your hospitalisation, you will be under medication when you are recovering. During this time, some medical insurance covers the policyholders as they reimburse the cost of the medicines purchased from the pharmacies included in their network. It would be best not to buy medication from anywhere except the enlisted pharmacies to avail of this benefit.

  • Add-on Coverage

You may need extra money if you are suffering from a critical illness such as kidney failure, cancer, and others. Under this vital condition, some health insurance providers provide add-on covers. The premium you need to pay if this clause is mentioned in your medical insurance will be slightly higher than standard medical insurance.

  • Reimbursement of Ambulance Charges

At the time of emergency, you may require an ambulance. Suppose you have invested in the right medical insurance. In that case, even that ambulance charge will later be reimbursed by your insurer.

  • Preventive Care Cover

To ensure that we stay healthy and fit, we often take preventive measures, including regular checkups and tests suggested by a healthcare provider. You should always choose the health insurance which will cover this preventative care.

8. Choosing a Plan and Enrolling

Before finally selecting a plan, review all the details regarding medical insurance. If all the specifications meet your family’s needs, choose the plan and invest in that.

Once you have selected the plan, you must go through the enrolment process. Read all the terms and conditions carefully once again before signing the documents. Read between the lines to know whether there are any hidden clauses and charges in it or not. There is always an enrolment deadline. You need to submit the signed papers and photocopy your original documents for verification. Once everything gets done, you will start paying premiums for your health insurance. Soon after the waiting period ends, you can avail of the medical insurance plan benefits.

9. Conclusion

That brings us to an end. Hopefully, now you have a profound idea regarding medical insurance plans. You should always get health insurance coverage not only for yourself but also for your loved ones. There are several medical insurance providers out there. You must choose the one according to your family’s needs and requirements. And as we have already told you, select your insurer, which has a short waiting period, prompt claim settlement record, and a vastly spread healthcare provider network, along with a few other essential aspects.


Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 27, 2023

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