Understanding Health Insurance
Health insurance can play an important role when it comes to medical bills and prescription medications—it can help protect you from high expenses. There are many types of health insurance plans. This can sometimes make understanding health insurance difficult.
The information below can help you make more informed decisions about health insurance. Because every health plan is different, you should speak directly to the health insurance plan provider if you have any additional questions or concerns.
Ways to get health insurance
Health insurance can be obtained in 1 of 2 ways: through a group or individually.
Group insurance
Group insurance might be offered to you through employers or organizations, such as unions or professional associations, to which you may belong.
Individual insurance
If you do not have access to group insurance, you may choose to purchase individual health insurance directly from an insurance company. Many people get individual health insurance through government programs such as Medicare and Medicaid if they are eligible.
Types of health insurance
Indemnity insurance
Also known as fee-for-service or traditional health insurance, indemnity insurance plans usually allow members to see the health care professionals and hospitals of their choice. Indemnity insurance plans pay only part of the medical bills for you. Usually, you will need to spend a certain amount each year before the plan begins to pay benefits. This amount is called a deductible.
Indemnity policies typically have an out-of-pocket maximum, so once expenses reach a certain amount in a given calendar year, the remaining cost usually will be paid in full by the plan.
Managed care plans
An alternative to indemnity health insurance plans, managed care plans allow members to select from participating health care professionals and hospitals. With managed care plans, costs tend to be lower when patients use participating health care professionals.
Each time you go to a health care professional or hospital, or fill a prescription, you will usually need to pay a co-pay. The amount of the co-pay will vary depending on whether the health care professional is a primary health care professional or a specialist, and whether the medication received is a generic or brand-name prescription.
Generally speaking, there are 3 types of managed care plans: health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (POS).
In general, what are the differences between HMO, PPO, AND POS plans?
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HMO
Premium is usually lowest of the 3 options
You select a primary care physician from the HMO network
Requires all doctors you see to be within the HMO network
Requires referrals for specialists and must be in the HMO network
Co-pay amount varies
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PPO
Premium tends to be more expensive than HMO
You choose to use a network or out-of-network doctor; you typically pay more for out-of-network visits and may need to pay for the treatment and submit the receipt to the insurance company for reimbursement
Co-pays for out-of-network doctors tend to be more expensive than in-network
Referrals for specialists usually are not required
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POS
Combines features of HMO and PPO
You choose a primary care physician (PCP) from the POS network
Care provided by in-network doctors with a referral from your PCP
You usually have the option to receive care outside the network without a referral from your PCP
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Always check with the health care professional before beginning any activity plan or increasing activity. It's also important to ask him or her about target heart rate to help determine appropriate exercise intensity.
Always check with your health care professional before beginning any activity plan or increasing your activity. It's also important to ask him or her what your target heart rate is to help determine what exercise intensity is appropriate for you.
Always be sure to check with your health care professional before beginning any activity plan or increasing your activity.
It always helps to ask:
- What activities are right for me?
- How much should I do each day?
- How many days a week?
It's also important to ask him or her what your target heart rate is to help determine what exercise intensity is appropriate for you.
This information is provided by an independent source. Merck is not responsible for this content. Please discuss any and all treatment options with your healthcare professional. The manufacturer of a product generally has the most complete information about that product.
This information is provided by an independent source. Merck is not responsible for this content. Please discuss any and all treatment options with your healthcare professional. The manufacturer of a product generally has the most complete information about that product.
This information is provided by an independent source. Merck is not responsible for this content. Please discuss any and all treatment options with your healthcare professional. The manufacturer of a product generally has the most complete information about that product.
Before making decisions about which policies, if any, to purchase, be sure to:
Thoroughly research policies
Review the coverage
Compare policy options
Download complete insurance quick reference [PDF 6 pages, 183k] including the health insurance options information on this page.
Before making Medicare choices, always:
Thoroughly review coverage
Compare options
Call Medicare at 800-633-4227 if you have any questions
Download complete insurance quick reference [PDF 3 pages, 160k] including Medicare and Medicaid information on this page.
There's even more support waiting when you sign up. You'll have practical help for setting and reaching goals as you customize your ongoing Health Plan.
You can sign up now. It's free.
Learn the benefits of signing up
Benefits of Signing Up
You can use many of the resources from MerckEngage® now. Or, sign up and build an ongoing plan for healthier living that's customized to your needs.
Once you're signed up, you can:
- Set goals and preferences for meal and activity plans
- Create, save, view, and update your plans anytime
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- Save and update your progress as you use condition tracking tools
Did your health care professional give you a Sign-Up Kit for MerckEngage Health Partnership Program?
You'll also receive:
- A Health Organizer—a binder for keeping health records and condition information all in 1 place
- Access to prescription savings on certain Merck medicines
- Updates, surveys, and health tips—based on your choices—to keep you motivated
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Sign Up
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What Is a Sign-Up Kit?
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If your health care professional has prescribed certain Merck medicines, he or she may have given you a Sign-Up Kit. A kit gives you the chance to access prescription savings—plus added benefits and additional helpful information for healthier living.
You can still sign up for MerckEngage without a kit. You'll be able to save and update your own customized Health Plan—which provides tools for meal planning, activity planning, and condition tracking—anytime at MerckEngage.com.
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Thank You for Your Interest in MerckEngage®
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MerckEngage is here to support your choices for healthier living.
A Sign-Up Kit from your health care professional lets you take advantage of additional benefits that MerckEngage offers when you join.
If you do not yet have your Sign-Up Kit from your health care professional, you can still sign up for MerckEngage now and update your information when you receive your kit.
Lost your kit? Speak with your health care professional to ask for another.
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The Sign-Up Kit from your health care professional lets you take advantage of even more resources from MerckEngage Health Partnership Program.
You Already Have Created A Meal Plan For This Time Period.
Saving this plan will replace some or all previously saved information for this period.
You Already Have Scheduled Activities For This Time Period.
Saving this plan will replace some or all previously saved information for this period.
Thank You for Your Interest in MerckEngage®
Unfortunately, because of state restrictions, residents of Maine are not eligible to sign up for MerckEngage Health Partnership Program.
We invite you to visit MerckEngage.com for health information and helpful tools that make healthier living simplified for you. Sign up for the Web site and get access to additional online features, too.
Health Coach Call
Listen to an example of what a call might sound like.
| Play | Nutrition call (7:16) |
| Play | Activity call (7:22) |
Here are some important things to know about your Health Coach Call:
Our Coaches are employed by a subsidiary of Merck & Co., Inc., a pharmaceutical company.
The information provided is based on generally available nutrition and physical activity guidelines and information applicable to most people.
Health Coaches are not licensed dietitians or health and fitness professionals, and they are not in a position to assess your individual nutrition or activity needs.
This information is not appropriate if you are pregnant, and it may not be appropriate if you have specialized dietary needs or limitations on the level of activity or exercise you can safely undertake due to your medical conditions. Consult your health care professional regarding your specific needs, limitations, and health conditions.
Health Coaches can educate and coach you on nutritional and physical activity recommendations for the typical person.
Health Coaches are not health care professionals and cannot offer medical advice, diagnosis, or treatment. Please consult your health care professional because he or she knows you best.
If you have a chronic health condition, check with your health care professional to find out if physical activity is safe before you start.
If during your call you have concerns about any condition, special dietary needs, limitations on the level of activity or exercise, any treatments, side effects, or adverse experiences, your Health Coach will refer you to your health care professional.
Activity Points Explained
This Planner uses Activity Points as a way to help you stay motivated and focused on your activity goals. Points are assigned to each activity in the Planner. You'll earn more points when you increase the duration of the activity.
For example, when you bicycle for 15 minutes at a moderate pace (12 to 14 mph), you earn 120 Activity Points. To earn the same number of Activity Points while cycling at a very easy pace (less than 10 mph), you would need to bike for 30 minutes.
If you are currently inactive or get very little activity during the week, a good goal to work toward is 500 Activity Points each week. This is equal to 30 minutes of moderate–intensity aerobic exercise on 5 days a week.
If you are moderately or highly active (more than 150 minutes of moderate-intensity activity each week), you may want to aim for up to 1,000 Activity Points each week. This is equivalent to 1 hour of activity on 5 days a week.
What you'll gain
At 500 Activity Points per week: Once you consistently reach this level (ie, 150 minutes of moderate–intensity aerobic activity per week), you may gain substantial health benefits. These benefits include lower risk of coronary heart disease, stroke, high blood pressure, type 2 diabetes, and depression.
At 1,000 Activity Points per week: When you consistently reach this level (ie, 300 minutes of moderate–intensity aerobic activity per week), you may gain even more health benefits. These benefits include a decreased risk of colon and breast cancer and an even lower risk of heart disease and diabetes.
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