What Does Comprehensive Health Insurance Cover?

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.

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.

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.

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.