What Does Comprehensive Health Insurance Cover?

Posted on February 6, 2018

Comprehensive Health Insurance: Know What it Covers

You've heard about comprehensive health insurance from friends or on TV. But what exactly does it cover? Click here to learn more about this plan.

We've all see the ads, we've heard it discussed - comprehensive health insurance. But, what is it really?

How comprehensive is "comprehensive?" There's got to be a catch, right?

Let's look a little closer at this popular form of health insurance. We'll look at what it is, what it covers, and what it doesn't.

Comprehensive Health Insurance - An Overview

So, starting at a very basic level, we know that health insurance is something that you can use to help control your health care costs. You buy insurance and then, when you need medical care (from a checkup to a more serious procedure), you can use that insurance to pay for part (or all) of your medical bill.

What determines that payment level is the type of insurance that you have. That doesn't mean "brand," but level i.e. a Bronze, Silver, Gold or Platinum.

Each "level" covers varying levels of services, at of course increasing levels of costs. It's important to remember that say a Gold level over here is not necessarily equal to a Gold level over there.

When it comes to comprehensive health insurance, you'll find that it generally comes in two parts - preventative care and then in-patient care. As we just discussed though, the term comprehensive can mean very different things to different companies. In recent years though there has started to develop a more definitive structure to the top of care covered.

Comprehensive Benefits

In 2014 the United States Government passed the Affordable Care Act. One of the stipulations of the ACA legislation is that insurance plans must offer care for ten standard medical essentials.

Those include:

  • • Hospitalization
  • • Emergency services
  • • Prescriptions
  • • Lab work
  • • Maternity and Newborn care
  • • Ambulance trips
  • • Help for mental health and substance abuse issues
  • • Physical rehab services
  • Children's health services
  • • Chronic disease care

What this gives us then is a baseline of insurance coverage. Comprehensive health insurance should give the policyholder a broader range of coverage.

Where Is It Coming From?

This is a big one and was a big push behind the creation of the ACA. The question is where is your insurance coming from, are you purchasing it as part of a group (i.e. an employer) or is it being picked up on an individual basis?

The reason this is important is because the more people purchasing a plan, the lower the costs of that plan will be. Conversely not only does an individual have a higher out of pocket and premium cost, but they traditionally seem a decline in the number of services covered.

But What About...

It is possible that your comprehensive health insurance plan doesn't cover everything you might need it or want it to. It's possible in fact that no plan will be as comprehensive as you like at the price point you have in mind.

When circumstances like that come up, you can look at supplementing your insurance with a limited coverage plan. Just as the name implies, those types of plans are generally focused on one specific concern.

Managed Care Plans

When investigating your insurance options you may have come across the term "managed care plans." This is a type of comprehensive insurance plan that creates a type of "partnership" if you will between doctor and patient in the care management plan of the insured.

In a non-managed care plan, you'd have the ability to sort of float easily around doctors but in a managed care plan you have a primary doctor who services as a type of health conductor.

There are actually three types of managed care plans:

  1. HMOs or health maintenance organizations
  2. PPOs or preferred-provider organizations
  3. POSs or point-of-service plans, or POSs

It should be noted that they are listed here in no particular order. Rather they are just three flavors of comprehensive insurance.

You'll often get involved in a plan like this through a group employer. In some cases, there are even perks as the insurer wants you to be healthy (therein they have less to pay to doctors and can make more) so they may include incentives in the plan for you attending well-visits or taking part in something like a nutrition plan.

Comprehensive Services, Comprehensive Costs

It can be difficult to look at an insurance plan and make a determination on whether it is the right plan for your situation strictly based on the cost of the plan. That's because there are a number of factors that can tilt your cost one way or the other.

Because of this, we can't examine the exact costs of any one specific Comprehensive health insurance plan. Instead, we can look at the cost structures that (generally) guide these plans.

When considering the costs of a plan you need to consider two numbers - your monthly premiums and the amount you'll need to pay for each medical need. The plans that only cover those ten mandatory health issues have a lower monthly premium but those are offset with something of a 60/40 for medical treatments.

That means that the insurance pays 60% of the bill and you are left with the remaining balance. As we've discussed, comprehensive health insurance can have a greater monthly premium but that's balanced by a treatment spend that falls closer to the 90/10 range. It's a trade-off but one that each person will have to weigh for their particular situation.

Get What You Need

Comprehensive health insurance can be a complicated topic. But it doesn't have to be.

There are professionals who have looked at the insurance industry from every available angle, they understand the laws, and they know the plans.

But, let's be honest, that's a very technical approach to insurance. While it is a technical product in a number of ways, it's also a very human one. that's why you want to make sure that the experts you engage with work with you to find the policy that fits your needs and not the other way around.

When you're ready to learn the latest in comprehensive health insurance options, we'd love to hear your story.

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