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Health Insurance: Understanding What It Covers

by host on Friday, February 26, 2016 4:08 AM

Any healthcare expense can cost you a lot and this is the reason why an appropriate health insurance policy is a must. It can reduce your healthcare costs when you are sick or injured. Before buying a particular health insurance policy, it is important to understand all the coverage options. Before choosing a health insurance plan, make sure you are aware of the coverage it provides. You also need to know about the money you need to set aside for buying an insurance policy.


Some of the popular coverage options provided under most health insurance policies include:

Maternity and newborn care
  • Emergency services
  • Hospitalization
  • Prescription drugs
  • Pediatric services


Apart from these, some other types of coverage are also provided. Different insurance companies offer varied benefits, so it is better to confirm before finalizing a policy. You also need to know the cost of your plan and if it is beneficial for you in the longer run. There are basically two methods to pay for your health insurance: a monthly premium and out-of-pocket expenses when you receive medical care. These expenses include deductibles, co-insurance and co-pays.


If you opt for a higher premium, you will be required to pay less when you receive medical care. Some companies also offer income-based subsidies that help in lowering the premium costs. Choose a plan depending on your health and financial situation. For instance, if you already suffer from a severe or long term medical condition, opt for a plan with a higher premium so that you get coverage for most of your costs.


The five main types of insurance plans are:

  • Managed care plans: Every health insurance plan consists of a network of doctors, hospitals and pharmacies. They are bound by a contract with the insurance companies and provide their services to plan members at a lower price. If a doctor is not in your policy’s network, the insurance company is not liable to pay your medical bill. 
  • Indemnity plans: In this insurance plan, you can select the doctor you want to consult. However, indemnity plans do not pay for all the medical and surgical expenses. You will get at least 80% of the costs, while the remaining 20% needs to be paid from your pocket.
  • Health Maintenance Organizations (HMOs): These organizations provide direct care to those insured. A fixed premium is paid to the HMO and it provides numerous medical services. You are not required to pay for individual services received by you. A primary care physician associated with the insurance plan works in tandem to provide the requisite services.
  • Preferred Provider Organization (PPOs): Similar to an indemnity plan, the PPO allows you to choose your health care provider or specialist.  
  • Point-Of-Service Plan (POS): It is a combination of HMO and a PPO wherein the insured person can choose either a general practitioner for his care or directly reach out to POS. Depending on the POS plan, the insured can get medical care from a primary care physician, PPO network provider services or services from non-network providers.


We, at Smith-Reagan Insurance Agency, offer health and life insurance in McAllen, TX. To request a quote, call at (956) 399 – 1353.


The auto insurance policies provided at Smith-Reagan Insurance Agency are specifically tailored for each client in San Benito and McAllen, TX

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