Adding the word "comprehensive" in front of the term "medical insurance" does not give it a specific technical or legal meaning. Insurance companies use the term mainly as a marketing device to mean "a wide range of coverage." Exact coverage varies widely with companies and policy terms. When shopping for medical insurance, look for a policy with coverage options that suit your particular needs.
Co-payments usually apply to health care services such as doctor visits and prescriptions for drugs or medicines. The policy establishes a specific amount that the insured must pay, and the insurance company covers the rest. As of the date of publication, typical co-pay amounts were $25 for doctor visits and $10 for prescriptions. Co-pay amounts and premiums may increase as time goes by and the cost of medical services goes up. The lower the co-pay amount, the higher the monthly premiums may be.
Deductible and Co-Insurance
Deductible amounts may apply on a yearly basis. If an insured person has an annual deductible amount of $1,000, the insurance company covers only the expenses that exceed that amount within a given year. Co-insurance divides expenses such as hospital care between the insured person and the company. For example, the insured may pay 20 percent of the bills over the deductible amount and the insurance company 80 percent. The lower percentage the insured pays, the higher the monthly premiums may be.
Group vs Individual
A person buying medical insurance as an individual will pay the highest price for the least amount of services,. but prices begin to decrease on a per-person basis when buying a policy for a family. Buying a policy for a specifically defined group may also reduce the price. Employers, churches, government agencies and other organizations may cover a larger number of persons for a lower cost for each. Some organizations require the insured persons to pay all, part or none of the fees.
Many insurance plans have optional features that may increase your premiums, and they may be important. Persons living in isolated areas, for example, may choose a medical evacuation option that would cover the cost of airfare or other transportation to get them to a medical facility. Younger couples may choose a policy that covers prenatal care and childbirth, whereas an older couple may not. Many companies offer an optional dental plan that may also have several options.
Richard Asmus was a writer and producer of television commercials in Phoenix, Arizona, and now is retired in Peru. After founding a small telecommunications engineering corporation and visiting 37 countries, Asmus studied broadcasting at Arizona State University and earned his Master of Fine Arts at Brooklyn College in New York.