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  • When Is The Right Time to Buy a Health Insurance Plan?

    The best time to buy an individual or family health insurance plan is right now. Seriously, the U.S. citizens have many problems with monthly payments for their insurances but it’s an absolutely necessary thing. The experts from Canadian Health&Care Mall recommend avoiding any postponing from buying a health insurance coverage. Especially, if your employer is not covering an insurance plan on his own.

    Peculiarities of U.S. health insurance plans

    When Is The Right Time to Buy a Health Insurance Plan

    The US health insurance system is not the most familiar and simple thing easy for a quick grasp. Insurance plans have many conditions and differences that Canadian Health&Care Mall can event count, there are so many of them. To begin with, every U.S. resident must have medical insurance. If you refuse from buying a health insurance, such decision will lead to the fact that at the end of the year you will have to pay a small tax for its absence.

    Most of all the employees of large companies are lucky ones. Large corporations and business are required to provide their employees with a fully-covered medical insurance. So, if you want to save money, look for a job in numerous American corporations, their branches and representative offices. There are also very inexpensive and free options for people with a monthly income that is lower than an average salary.

    Insurance terms and conditions in the USA

    In the US, you can buy insurance in a special two-month period (Enrollment period). It begins on November 15 and ends on January 15. This strict term is associated with protection against a potential fraud, when people start buying an insurance after the onset of illness, which causes losses to insurers. There is an exception. If you recently and completely legally moved to the United States or your family has changed, you can buy a new health insurance plan at any time of the year.

    Purchase of insurance is carried out in 2 way: directly via the insurance companies and through brokers whose services are free. A good broker will help you save money by offering the most profitable option among all U.S. insurance companies that he deals with.

    By the way, dental and ophthalmologic (eye) insurance claims are almost always sold separately from the main one (medical).

    The most common types of a U.S. medical insurance:

    1. Before buying, you will need to decide on the insurance type (PPO, HMO, EPO) and its plan (platinum, gold, silver, bronze);
    2. EPO limits its clients to treatment only in a specific network of medical clinics. The insurance will not cover the visits to private doctors;
    3. HMO requires you to choose a personal therapist (Primary Care Provider, PCP) who will assign you to visiting other healthcare specialists. Only in this case, the insurance will cover all medical appointments;
    4. PPO is the most budget-friendly option. You can independently choose which doctor to go for treatment. However, there are some limitations. If your chosen hospital or private doctor has entered into a contract with your insurance, then the services will cost you a small amount. If there is no contract, a treatment will turn out to be more expensive;

    After choosing the type of insurance, you will need to choose a plan on which your payments depend and how much your insuring company will compensate:

    • Premium — a monthly insurance fee;
    • Deductible – the amount of a medical bill after which the insurance begins to work. If the invoice for your treatment does not exceed this amount, you will pay it by yourself;
    • Co-pay% — what share of the bill you will pay after the insurance company. For example, the treatment costs $800, with a company’s part of $500 and a co-pay share of 10%. Then you pay out of your pocket: $500 + 10% of $ 300 on top of the company’s share = $ 530;
    • Maximum-out-of-Pocket. Limits are the ceiling of your expenses in a case of covered insurance claims. For example, if Maximum-out-of-Pocket = $ 5000, and the treatment cost is $ 600,000, then you will not have to pay a large percentage. You pay the agreed maximum — $5,000;
    • It is important to understand that even having the coolest insurance (Platinum PPO) and paying $1,000 per month, you will still have to pay out of pocket when visiting doctors ($20/40/100 per each visit);

    The most annoying feature is a lack of transparent prices. As a rule, you will receive the invoice by mail after the complete treatment and it is almost unreal to know the exact cost of services in advance. For example, the cost of an ultrasound procedure is $ 1400, you’ll get a discount of $700 and there are no any other deductions why this is happening.

    Medicine in the United States is not free. As the locals joke, buying insurance actually insures you against using it because it’s too expensive to use. You pay $5,000 – $15,000 per family per year to guarantee yourself an acceptable cost of medical treatment in a case of emergency.

    Let’s just compare the prices to understand if it’s required to get a medical insurance in the United States. Calling an ambulance with a fracture without insurance will cost you $11,000 and with insurance — only $240. The simple math is the best argument in this case.

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