A fee-for-service insurance policy (also called indemnity insurance) is a traditional form of health insurance. It pays a part of each medical service you receive, such as a doctor visit or hospital stay; you pay the rest of the cost.
With a fee-for-service plan, you can go to any doctor or hospital you choose. But you usually pay a higher monthly cost for your medical care than if you were part of a managed care plan.
Managed Care Plans
Many people receive health care through a managed care plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO.)
In managed care plans, health insurance companies contract with doctors and hospitals to provide health care to its members. These doctors and hospitals make up the plan's "network."
It's likely that you will be able to see only the doctors and hospitals that are part of your plan's network. Some plans, like PPOs, do allow the use of doctors and hospitals outside of the plan network, but you usually pay more.
In managed care plans, your visits to the doctor are prepaid by the plan. You typically pay a copayment, for example $20 to $35, each time you visit a doctor.
Association-Based Health Insurance
You might be able to buy health insurance through a trade or professional association you belong to. Many professional, community and religious organizations offer their members health insurance coverage at group rates. If you are a member of any trade or professional association, ask if it offers health insurance coverage. If it does, find out:
- How complete the coverage is
- How much of your medical expenses — from routine doctor visits and prescription drugs to major surgery — the insurance will cover
- How much it will cost each month
- If it covers family members
Your state insurance department can tell you what your rights are under association-based health insurance plans.
Pre-existing Condition Insurance Plans
As a result of the new health care law, the federal government has established pre-existing condition insurance plans (PCIPs) in every state.
In general, to get health insurance through a PCIP, you must:
- Have been uninsured for at least six months
- Have a pre-existing condition
- Have been denied health insurance coverage because of your health condition
- Be a U.S. citizen or national, or be lawfully present in the United States
PCIPs operate until January 2014, when small businesses and people without group health insurance will be able to find coverage through state-based health insurance purchasing pools called “health insurance exchanges.”