Get to know Health Insurance and its Benefits

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Get to know Health Insurance and its Benefits

Tips for choosing Health Insurance so as not to be fooled

The Best Health Insurance Company in the World that can be a Recommendation



Health Insurance

     Health insurance is a type of insurance coverage that typically pays for medical, surgical, prescription drug and sometimes dental expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly. It is often included in employer benefit packages as a means of enticing quality employees, with premiums partially covered by the employer but often also deducted from employee paychecks. The cost of health insurance premiums is deductible to the payer, and the benefits received are tax-free, with certain exceptions for S Corporation Employees.


Medical costs associated with the treatment of such diseases are increasing rapidly. In order to safeguard your finances against high medical bills, it is necessary to invest in health insurance plans. Such plans cover all hospitalization expenses, as well as pre-hospitalization and post-hospitalization charges.



Benefits Health Insurance;

1. Coverage against medical expenses

The main purpose of medical insurance is to receive the best medical care without any strain on your finances. Health insurance plans offer protection against high medical costs. It covers hospitalization expenses, day care procedures, domiciliary expenses, and ambulance charges, besides many others. You may, therefore, focus on your speedy recovery instead of worrying about such high costs.


2. Coverage against critical illnesses

Insurance providers now offer critical illness insurance, either as a standalone plan or as a rider. Such an insurance policy provides coverage against life-threatening diseases such as kidney failure, bone marrow transplant, stroke, and loss of limbs, among others. Upon diagnosis of any of the critical illness from the predetermined list of your policy, you are entitled to receive a lump sum amount. This amount may be used to meet your illness-related treatment costs, daily expenses, and any other financial obligations.


3. Cashless claim benefits

Many insurance providers offer cashless claim facilities. In such an arrangement, you do not have to make any out-of-pocket payments. The hospitalization expenses are settled between your insurer and the hospital. To avail of this benefit, it is imperative to get admitted at any of the insurer’s network hospitals. You may fill out a pre-authorization form and display your health insurance card to enjoy the cashless facility.


4. Additional protection over and above your employer cover

Many organizations cover their employees with a group insurance plan. However, such policies are not tailor-made according to the needs of every individual. Besides, you may be left uninsured in case of loss of job or change in employment. In order to protect yourself against such an event, purchase a health cover individually.


5. Tax benefits

Health care plans provide tax benefits. Premiums paid towards your health care policy are eligible for tax deductions under Section 80D of the Income Tax Act, 1961. The quantum of deduction is as under.



Tips for choosing Health Insurance

1. Consider Your Health

If you have one or more medical conditions that require ongoing care, such as diabetes or heart disease, you want a plan with a lower deductible and lower copayments. Same applies if you think you may be expecting a baby in the coming year. You’ll pay a higher premium, but your overall out-of-pocket costs may be lower.


2. Do the math

People focus on the monthly premium, but you also need to look at the deductible. For instance, if you have a choice between a lower silver plan premium of $ 345 a month for a plan with a $ 5,500 deductible, and a higher gold plan premium at $ 465 a month with a $ 1,750 deductible, you’re better off with the second plan if you anticipate needing more than $ 1,500 in medical care. With the second plan, your total annual cost for the premium and deductible comes to $ 7,330, a $ 2,310 savings over the lower premium plan.


3. Look at out-of-pocket costs

The deductible is just one out-of-pocket expense; you also have copayments and coinsurance. The three together are your maximum out-of-pocket costs. Under the Affordable Care Act, the maximum out-of-pocket limit is $ 7,150 for a single person and $ 14,300 for a family policy.


4. Review the provider list

Most health plans today have “in-network” providers. If you see those doctors and visit those hospitals, you pay less out of pocket than if you go outside the network. So if you want to keep your own doctor and go to a certain hospital, make sure they’re on the provider list.


5. Read the list of benefits

All individual and small business plans have to cover hospitalization, emergency services, lab tests, maternity and newborn care, mental health and substance abuse treatment, outpatient care (doctors and other services received outside the hospital), pediatric services (including dental and vision care ), prescription drugs, preventive services, and rehabilitation services. The specifics of your employer’s available plans, however, may differ significantly, so be sure to read the plan’s Evidence of Coverage.


6. Look at the drug list

All plans have a formulary, a list of medications they cover and the copayment for each. If you take prescription medicine, check the list to see if your drug is on it and how much refills will cost. If your medication isn’t on the formulary list, you may have to pay for it in full. Also, see if your plan offers a money-saving mail-in prescription option for prescriptions you take on a regular bases.

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7. Ask the right questions

Call the member services department of the health plan you’re considering or talk with someone in your human resources department and ask: Which doctors, hospitals, clinics or pharmacies participate in the plan? How much does it cost to go out of network? Am I covered during a travel emergency? What is the premium and out-of-pocket costs? What is the most I’ll have to pay out of my own pocket to cover expenses? Exactly what benefits are covered by the plan and what isn’t covered? How are disputes about a bill or service handled?

Best Health Insurance

An impressive 43 Aetna Medicare Advantage plans sold in 37 states, plus the District of Columbia, received top NCQA ratings in 2019, with Connecticut and Maine being standouts.1 In 2020, Aetna Medicare Advantage plans were made available in 264 new counties across the country, providing millions more Medicare beneficiaries access to an Aetna plan. The insurer also sells Medicare supplement plans (Medigap) and prescription drug plans in most U.S. markets (43 states) as well as a combination dental, vision, and hearing supplemental Medicare product in many states. 

In the private arena, Aetna is a large provider of employer-based health insurance. A total of 4 Aetna plans serving Idaho, Iowa, Pennsylvania, Utah, and Wyoming made the top NCQA ranks in 2019,2 and the 2020 J.D. Power U.S. Commercial Health Plan Study highly ranked the Ohio and Virginia Aetna plans.3 In addition, Aetna’s pricing seems to be at a lower level than many competitors.

In November 2018, Aetna became part of CVS Health Company, and synergies between the two are beginning to emerge.4 For example, Aetna medical plan subscribers with high blood pressure can get a free home monitor at CVS. Chronic disease monitoring may also be available at CVS stores.



Blue Cross Blue Shield

One out of 3 Americans has health coverage from Blue Cross Blue Shield. The names on various state plans include Anthem, Independence, Hawaii Medical Service, Highmark, and Wellmark, but the 36 independent and locally operated Blue Cross Blue Shield companies open doors in all 50 states. Nationwide, more than 90% of doctors and hospitals contract with Blue Cross Blue Shield companies—more than any other insurer.

In 2019, more than 40 Blue Cross Blue Shield company plans earned moderate to high ratings from NCQA based on clinical quality and member satisfaction,5 while 10 Anthem plans—including some with lower overall ratings—scored impressively in the customer satisfaction area.6 The Blues offer employer insurance, individual policies on, and a variety of Medicare plans (Medigap, Prescription Drugs Part D, and Medicare Advantage).



It’s not surprising that a company that sells a product called Expatriates Insurance would lead our list for international coverage. This global health service company has 17 million medical customers worldwide served by a global network of 1.5 million healthcare professionals with access to doctors in 30+ countries. It has more than 70,000 employees. Cigna followed on the heels of Aetna and CVS Health in 2018 by partnering with Express Scripts, the nation’s largest pharmacy benefit manager, in a deal aimed at lowering costs and improving care.7

In the U.S., 4 private Cigna plans were top-rated in NCQA.8 Although Cigna was a top performer in customer satisfaction in the Southwest U.S., according to the 2020 J.D. Power survey,3 it was ranked among the worst in its industry for member satisfaction by the American Customer Satisfaction Index (ACSI) in 2020.9 Cigna sells medical plans in 10 states and dental plans in all 50, plus D.C. It sells individual plans on in 19 markets across 10 states. Cigna also expanded its Medicare Advantage plans to reach a total of 369 counties across 23 states, adding coverage in 5 new states for 2021.



Health insurance policies don’t usually cover such expenses as eyeglasses and contacts; or dental exams, crowns, and appliances. Humana, a broad-based health and well-being company, sells private policies in all these areas, and the company has a range of plans for people living with chronic conditions that include transitions from a hospital stay to home care and meal delivery. Humana is also among the companies that offer special needs policies for people with a severe or disabling chronic condition or living in an institution. As of 2018, Humana no longer offers individual medical plans but focuses on healthcare solutions for employers.

Four private Humana plans (Kansas/Missouri, Wisconsin, 2 in Illinois) and 3 Humana Medicare Advantage plans (Florida, Illinois, Tennessee) were highly-rated by NCQA.10 11 Humana led the pack for customer satisfaction among health insurers in 2020, according to data from the ACSI survey.9 Humana’s policies for HMOs are relatively affordable.

The nonprofit insurer Kaiser Foundation Health Plan—part of Kaiser Permanente—won stellar ratings for private insurance, with 1 plan (Mid-Atlantic States) getting a top overall NCQA score of 5.0 and 7 other plans, ranging from Georgia to California, winning 4.0 to 4.5 ratings.12 In the Medicare Advantage arena, Kaiser was also a winner with 8 plans in the very top echelons.13 The company operates in 8 states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington) and Washington, D.C. 

All of Kaiser’s highly rated private and Medicare Advantage plans are HMOs. This is good news for those needing budget health insurance because HMOs have lower premiums, no deductibles, and lower copays and prescription drug costs. The downside to an HMO is the stipulation that—except in emergencies—you must use only doctors, hospitals, and other services that are in the network. The plans do, however, deliver the same essential goods as a PPO plan. Kaiser’s policies have relatively low premiums.



Want to track your health on an Apple Watch? File claims, set up doctor appointments, and find doctors online? United Healthcare’s latest annual survey found that 37% of consumers shop for health care on a computer or with mobile apps.14 The company is pushing “consumer-driven digital health care,” which includes wearable technology for glucose management, smart baby monitors for high-risk infants, and activity trackers that allow fitness participants to win monetary awards.

Two private United Healthcare plans (both in Rhode Island) scored an impressive 4.5, while 11 plans in 5 states (Iowa, Massachusetts, Nebraska, New Hampshire, Wisconsin) scored 4.0 in overall NCQA ratings.15 An impressive 34 of its Medicare Advantage plans were highly rated, including several sold under the name Sierra Health and Life Insurance Company.16

United offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries. It contracts directly with more than 1.3 million physicians and care professionals as well as 6,500 hospitals and other care facilities nationwide. Both HMO and PPO plans are available with access to health savings accounts (HSAs) and flexible spending accounts (FSAs). Its polices may cost a bit more than some of its competitors, but it may be worth it for the extra features.



Under the names Group Health Plan and HealthPartners, this company sells Medicare plans in Minnesota and Pennsylvania. All 3 of its private plans garnered 4.5 overall scores from NCQA.17

Those suffering from diabetes may like this plan as one of HealthPartners’ promises to consumers is to provide monthly supplies of insulin for no more than $25.

Overall, the company offers three separate plans in Minnesota and two separate plans in Wisconsin, depending on where you live and your specific coverage needs. The most options are available for those living in the Twin Cities area of Minnesota.



This New England not-for-profit company has 4.5-rated plans in 2 states (Maine, Massachusetts), 1 of which also scored an impressive 4.5 on prevention, and a 4.0-rated plan in New Hampshire.18 The Harvard Pilgrim Choice Plus and Options PPO plans are offered jointly by Harvard Pilgrim and UnitedHealthcare, allowing members access to a network of half a million doctors nationwide, thousands of hospitals, and flexible health benefits.



This not-for-profit, physician-directed health plan has some of the highest rated plans in the business. Two plans garnered a 5.0 in overall score from NCQA,19 and were among the 6 private plans nationally that scored 5.0 in consumer satisfaction.20 A third plan from CDPHP came in near the top at 4.5,19 and the company’s Medicare Advantage plan was also a high scorer.21 The plans are available in 29 of New York’s 62 counties. The company notes that 8 out of its 15 board members are practicing physicians.

Best Health Insurance Companies :

Best for Medicare Advantage: Aetna

Best for Nationwide Coverage: Blue Cross Blue Shield

Best for Global Coverage: Cigna

Best for Umbrella Coverage: Humana

Best for HMOs: Kaiser Foundation Health Plan

Best for the Tech Savvy: United Healthcare

Best for the Midwest: HealthPartners

Best for New England: Harvard Pilgrim

Best for New York: Capital District Physicians’ Health Plan

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