September 7th, 2009 
Admin 
The United States does not have socialized medical care. If you have no health insurance coverage, you have to pay for health care out of your own finances at the time of service. This can run into many thousands of dollars for serious illnesses.
You buy health insurance for the same reason you buy other kinds of insurance: to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very expensive.
You cannot predict what your medical bills will be. In a good year, your costs may be low. But if you become ill, your bills could be very high. If you have health insurance, many of your costs are covered by a third-party payer, not by you. A third-party payer can be an insurance company or, in some cases, it can be your employer.
Many people in the United States are enrolled in some sort of managed care health insurance plan. This is an organized way of both providing services and paying for them. Different types 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.
Individuals enrolled in health care plans pay a monthly or quarterly fee as insurance for the time when they will need medical attention. At the time when a service is provided, the health insurance organization pays part or all of the fee, minimizing the amount you have to pay at the time 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 to find out how to choose a health insurance plan that best meets your needs and your financial circumstances. Definitions of the health insurance terms used are included in the section called Understanding Health Insurance Terms.
Understanding Health Insurance Terms
Coinsurance
The amount you are required 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 health insurance company pays 80 percent of the claim, you pay 20 percent.
Coordination of BenefitsA system to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100 percent of the claim.
Co-payment
Another way of sharing medical costs. You pay a flat fee every time you receive a medical service (for example, $5 for every visit to the doctor). The health insurance company pays the rest.
Covered ExpensesMost health insurance plans, whether they are fee-for-service, HMOs, or PPOs, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures the insurer agrees to pay for. They are listed in the health insurance policy.
Customary 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 will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay. To avoid this additional cost, ask your doctor to accept your health insurance company’s payment as full payment. Or shop around to find a doctor who will. Otherwise you will have to pay the rest yourself.
DeductibleThe amount of money you must pay each year to cover your medical care expenses before your health insurance policy starts paying.
ExclusionsSpecific conditions or circumstances for which the policy will not provide benefits.
HMO (Health Maintenance Organization)Prepaid health plans. You pay a monthly premium and the HMO covers your doctors’ visits, hospital stays, emergency care, surgery, checkups, lab tests, x-rays, and therapy. You must use the doctors and hospitals designated by the HMO.
Managed Care
Ways to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care.
Maximum Out-of-Pocket ExpensesThe most money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the health insurance company, in addition to regular premiums.
Non-cancellable PolicyA policy that guarantees you can receive health insurance, as long as you pay the premium. It is also called a guaranteed renewable policy.
PPO (Preferred Provider Organization)A combination of traditional fee-for-service and an HMO. When you use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. You can use other doctors, but at a higher cost.
Pre-existing ConditionA health problem that existed before the date your health insurance became effective.
PremiumThe amount you or your employer pays in exchange for health insurance coverage. Primary Care DoctorUsually your first contact for health care. This is often a family physician 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 is needed. In many health insurance plans, care by specialists is only paid for if your are referred by your primary care doctor. An HMO or a POS plan will provide you with a list of doctors from which you will choose your primary care doctor (usually a family physician, internists, obstetrician-gynecologist, or pedicatrician). This could mean you might have to choose a new primary care doctor if your current one does not belong to the plan. PPOs allow members to use primary care doctors outside the PPO network (at a higher cost). Indemnity plans allow any doctor to be used. ProviderAny person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.
Third-Party PayerAny payer for health care services other than you. This can be an insurance company, an HMO, a PPO, or the Federal Government
Watch the video related to health insurance
Spinach and carrots health insurance commercial. Really cute little boy and girl.
Help answer the question about health insurance
How do health insurance tax deductions work for a member managed LLC?I own a business (LLC) with two other people. It is only us three; we do not have any additional employees. We pay for our health insurance through our business. Based on these facts, I was wondering how much I stand to save on my personal taxes. Is this a standard write off like any other business expense or does the IRS treat health insurance differently?
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Nitin Gupta
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Actually of the 5 richest in congress and senate, 4 are Democrats. Congressman Darrell Issa (R-California) is the only Republican in the top 5. Historically Republicans have been more educated and more affluent, but after 2008 the title has swung to the Democratic party for the first time since 1964.
Ever heard of reform? That’s when Congress passes laws to make sure companies abide by certain limits.
I don't know why they will need proof of income it's really none of their business… I work @ dr.office and i never heard that!! we only be concern about patient's having their co-payment and correct insurance card. Called the doctor office and ask to speak to an office manger to what are their requirements?? Good Luck
Most of the time its for internal records but sometimes its used to check previous medical records.
The problem with this is democrats are just as rich as the republicans, I don’t think this is a personal wealth issue.
After all, politicians from both sides get no where legislating for their own needs but instead legislating for their constituents so they can get re-elected.
US Government already spend as much per capita on healthcare as Canada, while Medicare and Medicaid already work so well, I don’t blame many for not wanting to rock the boat, but the system still needs reform.
But much worse. Since now they will only have to lobby one entity and people will have no alternatives unless they are made of money or excluded from having to live under the plan such as politicians and their cronies.
“. . .and for them to be responsible. . .”
Maybe if we just said, “Pretty please?”
It looks like a non easy cracking nut,looking around here http://www.InsuranceFreeTip.info/insurance-for-free.htm ,you may find something useful for you.
You’re a moron. We live in a capitalist society. They’re entitled to make a profit. We need reform and for them to be responsible, not socialist takeovers.
UIM or underinsured motorist is for pain & suffering & lost wages & loss of daily function (stuff that health insurance does not pay) that happens to you when an at fault driver does not have enough liability insured to cover your injuries. Your medical insurance is fine but I am sure you have a deductible & copayments. Medical payments under a motorcycle policy usually does not & should be primary in an accident.
The UIM is totally different than health insurance. I wouldn't go anywhere without it. Some states require it, mine does.
optmystik – Just another spoon-fed idiot who is comfortable living in his bubble of cliches. You have no idea what conservatives are like. Studies performed by left leaning organization have measured the charitible donations given by conservatives and liberals and have been shocked to find that cons give 50-100% more in charity, volunteer more of their time, and are poorer than liberals. I remember hearing the guy who did this state over and over again how he couldn’t believe it. What a dope.
You don't have to have health insurance to get a check-up.
Just like you said, car insurance doesn't pay for oil changes, but YOU have to pay for it, maybe $25.00. But if you get a complete check-up on your car, such as computer anaylsis, you may have to pay $150.00 – $600.00. The oil change and computer analysis on my car costs close to $600. I think you can get a physical check-up for less than that. If you don't have insurance, YOU have to pay for it.
Healthcare is very expensive. Here are some of the reasons:
Doctors and hospitals have to be insured with medical malpractice insurance. For a specialist, that coverage could cost as much or more than $100,000 per year. The hospitals medical malpractice insurance is greater than that; in the millions.
Doctors have to earn a good living just to pay the insurance, in addition to their living expenses, student loans, etc.
All the technical instruments that hospitals and doctors use are very expensive in this day and age of technology. Some are valued in the millions of dollars. Somebody has to pay for those.
Some medications are extremely expensive.
I'm a cancer patient. So far my medical bills are nearing $750,000. My chemo treatments are over $20,000 per month. Thank God for insurance.
Remember, this is not the 70's and 80's, so doctors and hospitals are not using 70's and 80's technology.
BTW, an oil change in the 70's was about $6.00.
I don't think there really would be an affordable rate for some of us. I am disabled, can't work, have to see specialists all the time, can't get any assistance on medical bills, and barely make it every month on $ 800.00
per month. Where could it be affordable.
I would assume they would lower their prices, and would hope so. I can't get insurance anyway. The medical bills just stack up and maybe 5- 10.00 pr. month. I am 17.00 over the income limit for medical assistance in my state, how stupid can that be.
Those Dr's have went to college and much more for many years to get where they are and I believe they do deserve a good salary. But now a stay and surgery of some is over 100,000.00.and that is just the hospital and extras.
It is so complicated. I just wish we all could have some decent health care.
I'm on public insurance as I am a military retiree.
Every private Health insurance plan I see, is a complete piece of shit.
I have a daughter that had major medicial and I am so thankful I worked for the govermetn and all of myc civilian friends in the private sector from farmers to retail workers –they have crappy healt care plans if any and nothing but trouble. It sucks to be a non-goverment working American that isn't emplyeed by a state or county health care plan. And if someone talks Union at WallMart the communist police will arrest you. The goverment won't even allow you to sign card to join one (I thought we had the reight to assemble and that should be join any thing we want in any way that we want) But by damb corporate America might have to pick up some health care benifits.
Every friend I have from Europe and or Canada, literally shakes their head at our system. It's an embarassment.
For-profit health insurance should be made illegal.
The incoming president of the Canadian Medical Association, said her countrys govt run health care system is sick and imploding.” For health care reform to be successful, they have to reduce costs, and the only way in fact to reduce cost is to reduce services and ration care. That’s why their system is collapsing. Are there any govt run entitlement programs that run efficiently and on budget? Are Medicare, Medicaid and the VA hospital system ran well? Has the govt ever lied to anyone?
We don't need it. 89% of people are happy with their coverage. What we need is to get overall costs down some to help those not covered to afford their own coverage. The way to drive costs down is not to implement massive government control. You can't forcefully lower the cost of something without supply running out. Health care may be a service but it still follows the laws of supply and demand.
If you don't like freedom of choice and you enjoy long waiting lines for mediocre care, then national health insurance is for you.