State Farm Medical Insurance – Overview
State Farm Medical Insurance is on a mission to help individuals manage the risks of everyday life. The insurance company focuses on helping policyholders recover from unexpected medical expenses and prevent medical debt.
With a major marketing alliance with Blue Cross Blue Shield, State Farm Insurance helps individuals to get major medical insurance coverage. Everyone knows just how important medical insurance coverage is as it ensures efficient and prompt health and medical care services for policyholders in the United States. Personal medical coverage offers the necessary benefits as regulated by the Affordable Care Act.
Let’s take a quick look at the types of health insurance policies offered by State Farm Insurance in the United States.
Types of State Farm Health Insurance
You can make the correct decision when buying health insurance when you know the different options available. Health insurance is not a one-size-fits-all, and the options highlight this fact. To determine the best-suited health insurance, it is recommended to check two aspects of any insurance policy.
Firstly, you should decide on the health insurance categories that suit you. Health insurance categories are the way you and your insurance provider share medical and health coverage costs. Besides this, you should also determine the type of health insurance, as it decides the extent of insurance coverage.
Health Insurance Categories
State Farm health insurance is divided into 5 main groups. Every individual group has a different ratio of financial responsibility between you, the insured, and State Farm, the insurer.
The five types of health insurance categories are:
Bronze – You pay 40%, while the insurer pays 60% of total healthcare expenses.
Silver – You pay 30%, while the insurer pays 70% of total healthcare expenses.
Gold – You pay 20%, while the insurer pays 80% of total healthcare expenses.
Platinum – You pay 10%, while the insurer pays 90% of total healthcare expenses.
Catastrophic – If you meet a high deductible, then the insurer pays 100% of medical expenses.
Remember, the more the insurance carrier pays. The higher will be the monthly premium cost of the particular insurance policy. Some individuals choose Bronze or Catastrophic if they don’t expect significant medical expenses. On the other hand, individuals who expect a major medical care requirement or need multiple medications frequently tend to choose Silver, Gold or Platinum health insurance categories.
5 Types of Health Insurance
Also, there are 5 main types of health insurance policies/plans:
1 – Health Maintenance Organization (HMO)
HMO insurance plans normally have limited coverage features and are effective only when getting health care services for doctors within the insurance carrier’s support network. To get this type of health insurance, you must first consult with a primary care physician and get a referral from the physician to see a specialist so the expenses can be covered under your HMO insurance plan.
In addition, this type of health insurance covers the cost of receiving medical care at out-of-network hospitals but only for medical emergencies. However, for any other visitors to an out-of-network healthcare provider, the policyholder has to bear the complete cost of treatment.
2 – Preferred Provider Organization (PPO)
A PPO health insurance is a type of insurance policy where you don’t have to pay more if you use in-network health care providers and don’t require visiting a specialist. Under this type of health insurance, you can visit doctors, hospitals and other health care providers outside the support network without paying any additional cost.
3 – Exclusive Provider Organization (EPO)
An EPO is very similar to an HMO type of health insurance. Under this health insurance policy, you have to bear the complete cost of receiving medical treatment at out-of-network healthcare centers, except for emergencies. However, under this type of health insurance plan, you get more in-network healthcare provider choices and do not need a referral from your primary care physician to see a specialist.
4 – Point of Service (POS)
POS health insurance plans require you to pay less if you use services of in-network doctors, hospitals and health care providers. This type of health insurance plan will require you to get a referral from your primary care physician if you want to visit a specialist and have the cost covered under your insurance.
5 – High Deductible Health Plans (HDHP)
An HDHP has a higher deductible than conventional insurance plans and also higher annual out-of-pocket expenses. This type of health insurance plan can be combined with a Health Savings Account (HSA), allowing you to pay for certain medical expenses with tax-free money.
Regardless of the type of health insurance coverage or health insurance plan you choose, every plan must cover 10 basic health benefits.
Before buying, ensure that the medical coverage includes emergency medical care, outpatient services, pregnancy and newborn care, hospitalization, prescription drugs, mental health and substance abuse services, lab services, preventive health care, rehabilitative services and pediatric care. For more details on individual State Farm medical insurance policies and plans, you can visit the official website at https://www.statefarm.com/.