Let’s face it–in today’s world, health insurance is a necessity. In fact,  most U.S. 公民和合法居民必须有合格的医疗保险,否则将面临罚款. Yet the cost of medical care is soaring higher every year, and it’s becoming increasingly difficult (and in some cases, impossible) to pay medical costs out of pocket. Whether you already have health insurance or want to get it, here’s some basic information to help you understand it.

Not part of a group? You may have to go it alone

你可能有团体健康保险,或者可以通过你的雇主购买. Group insurance is most commonly offered through employers. 它也通过一些公民团体和其他组织提供(e.g., auto clubs, chambers of commerce). A single policy covers the medical expenses of a group of people. 所有合资格的团体成员,不论年龄或身体状况,均可享受团体保险. 团体保险的保险费是根据团体的整体特点来计算的, such as average age and degree of occupational hazard. It’s generally less expensive than individual insurance.

If you can’t join a group, consider buying individual insurance. Unlike group insurance, 个人保险直接从保险公司或保险代理人处购买. 当你申请保险时,保险公司会根据你给保险公司带来的风险来评估你. 你的潜在风险将决定你是否有资格购买保险以及保险的费用, depending on state laws. You must pay the full premiums yourself.

If you have to go it alone, 你可以在各州的平价保险市场购买健康保险. You can compare health plans according to price and quality, 最终购买一份最能满足你健康保险需求的平价计划.

Know what’s out there

你的健康保险提供的保护的成本和范围将取决于你的保险供应商和你购买的特定政策. 你可能拥有涵盖多种类型的综合健康保险, or basic coverage that includes hospital, surgical, and physicians’ expenses. 此外,在发生灾难性事故或疾病的情况下,有必要提供大的医疗保险. 许多计划还包括处方、心理健康服务和其他与健康有关的活动(e.g., health-club memberships).

说到健康保险,HMO, PPO和POS不仅仅是字母. 你需要知道可用的健康计划的类型,以便做出明智的决定. 你可以通过传统的保险公司如蓝十字/蓝盾获得健康保险, health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service (POS) plans, and exclusive provider organizations (EPOs).

  • 传统保险公司:这些计划通常允许你灵活选择医生和其他医疗保健提供者. Some policies reimburse you for covered expenses, while others make payments directly to medical providers. 你将支付一个免赔额和每个账单的一个百分比,这被称为共同保险.
  • hmo:健康维护组织只覆盖由医生及其网络内设施提供的医疗服务. You must choose a primary care physician, 谁会批准或拒绝任何看专家的请求. 你通常每月支付固定的医疗保险费用,以及少量的共同支付(e.g., $10 for each office visit and prescription).
  • PPO:首选提供商组织不要求成员寻求PPO医生和医院的治疗, 但这样做通常有很强的经济动机(按偿还比例计算). 你通常每月支付固定的医疗保险费用,以及少量的共同支付(e.g., $10 for each office visit and prescription).
  • pos:服务点计划结合了HMO和PPO的特点. 您必须选择一位初级保健医生负责您在POS网络中的所有转诊. 尽管你可以选择使用这种类型的计划去网络之外, your health care will be covered at a lower level.
  • EPOs:独家提供商组织基本上是ppo,但有一个重要的区别:EPOs不覆盖非网络医疗.

Read your contract

你应该基本了解你的保单包括什么,不包括什么. 这可以帮助您防止意外的医疗账单到达您的邮箱, because you’ll know ahead of time, for instance, whether or not liposuction is covered. 您必须仔细阅读您的保单,特别是限制和排除条款. The specifics will vary from policy to policy. 一般来说,大多数政策至少会提到以下几点:

  • 既存状况:在投保前就开始或发生的疾病或伤害. 《365app官方版下载》(Affordable Care Act)取消了覆盖基本健康状况的医疗保险政策或计划拒绝覆盖已存在疾病的能力. 但是,除了基本的保健福利外,还可以附加原有的条件.
  • 福利不重复:福利将不会支付其他保险公司报销的金额.


  • 免赔额:在保险开始前你必须支付的金额(通常是每年的数字)
  • 共同保险:每一份医疗账单中你负责的部分
  • 自付:每次看医生或开处方都要付的固定费用
  • 家庭保险:许多团体保险允许你以更高的保费覆盖你的配偶和家属
  • Out-of-pocket maximum: This provision is designed to limit your liability for medical expenses in the calendar year; you won’t have to make coinsurance payments in excess of this figure
  • 利益上限:保单规定的最高终身赔付额,通常至少为100万美元

In conclusion, 拥有健康保险是每个人生活和财务计划的一个重要方面.  有很多选择,有一些基本的信息可以帮助你评估什么适合你和你的情况.

At Austin Asset, we are Fee-Only Financial Advisors. 365app官方版下载寻求通过真实和持久的关系为财富带来清晰和目的. For Life.

Up Next

A Note to Our Clients Regarding COVID-19

Read More »

Charitable Giving in 2021

Read More »

Sign Up for Our Newsletter