If you’re looking to better budget for health expenses, hospital and doctor insurance can be the way to go. Learn how it can help.

1. What is hospital and doctor insurance?
2. Why might I need hospital and doctor insurance if I already have health insurance?
3. What services does hospital and doctor insurance cover?
4. Do I have to use a network provider for hospital and doctor insurance?
5. Is hospital and doctor insurance renewable?
6. How much does hospital and doctor insurance cost?
7. Is hospital and doctor insurance available in my state?

Even if you’re happy with your health insurance plan, there are some things it won’t cover. That may include your plan’s deductible or the copays you owe every time you see a specialist or get a prescription drug refill. It might also include out-of-pocket costs for hospital stays.

It can sometimes be hard to budget for health expenses, which is where hospital and doctor insurance can be helpful. It may help fill some of those gaps, making it easier for you to afford the health services you need.

Read on to learn more about hospital and doctor insurance, as well as how it might be able to help you better budget for health care expenses.

What is hospital and doctor insurance?

Hospital and doctor insurance is a type of supplemental insurance that can help you pay for eligible medical services by providing you with cash benefits. It’s designed to help you handle out-of-pocket costs that your main insurance doesn’t cover.

Instead of paying you a lump sum like some supplemental plans do, hospital and doctor insurance pays your provider directly, just like health insurance does. If there’s money left over, you receive the difference.

You also don’t need to pay a deductible to get hospital and doctor insurance. It starts paying for most services as soon as you receive a covered service.

If you buy hospital and doctor insurance through UnitedHealthOne, for example, you might also see it called Health ProtectorGuard. Want hospital and doctor insurance? Browse your plan options now, or contact a licensed insurance agent at 1-844-211-7730 to discuss them further.

Why might I need hospital and doctor insurance if I already have health insurance?

If you already have health insurance, you probably know that it doesn’t cover 100% of your health care costs. And it doesn’t even start paying for most services until you’ve met your annual deductible. If you use a lot of health care services, you might face significant out-of-pocket costs. Hospital and doctor insurance can help you cover those costs.

“The main reason that I recommend this type of supplemental plan, even if someone already has insurance, is for my traveling clients to have access to a broader network of providers when outside of their primary plan’s network,” says Kyle Henson, owner of Nomad Insurance Group in Livingston, Texas.

If you have an Affordable Care Act (ACA) plan, for instance, you could run into trouble with access to providers, notes Henson. That’s because most ACA plans have network requirements. (But ACA plans do offer you health services regardless of whether you have a preexisting condition.)

Can I use hospital and doctor insurance in place of an ACA plan?

The simple answer is no. Here are 3 reasons you can’t use hospital and doctor insurance in place of an ACA plan:

1. Even if you’re interested in hospital and doctor insurance, you’re not guaranteed to receive it; getting approved requires medical underwriting, which means the insurance company will review your medical records and you may be denied coverage if you have a preexisting condition like type 2 diabetes.
   
   Note: It’s important to give accurate information. If you provide incorrect or incomplete information on your application, your insurance company could stop your coverage and your claims might be denied.
   
2. Hospital and doctor insurance is a type of supplemental insurance, which does not offer the same coverage as major medical insurance. It doesn’t cover all the services that a comprehensive health insurance plan does, including some of the 10 essential benefits that all ACA plans are required to have. For example, hospital and doctor insurance usually doesn’t cover pregnancy, maternity and newborn care.
   
3. Hospital and doctor insurance pays you a fixed amount for services you receive, regardless of what the costs are that you’re ultimately billed for. If you don’t have other health insurance to cover them, you might have to pay the balance of those costs. And that can get expensive quickly.

“Rarely do I recommend that someone enroll in a hospital and doctor plan as a primary plan, because it can be risky in that there are no out-of-pocket maximums,” says Henson. “This can leave a member potentially exposed in the case of a catastrophic medical event.”

If you have a heart attack or are diagnosed with cancer with no out-of-pocket maximum, for instance, expenses can add up quickly.

“These things are designed to do only what they’re designed to do,” says Dave Trout, managing agent at Trout Insurance in Weaverville, North Carolina. “So, there’s a real possibility that someone may have a medical situation that they think is covered, but basically in the details of the policy it’s not.”

What services does hospital and doctor insurance cover?

Hospital and doctor insurance covers 2 broad groups of health care services:

• Hospital services such as hospitalization, surgery and diagnostic testing
• Routine services such as wellness exams, office visits and prescriptions

First, let’s dig a little deeper into the routine services category, which includes wellness exams, office visits and prescriptions coverage, which UnitedHealthcare’s Health ProtectorGuard (HPG) plans call “WORx benefits.”

Do you have questions about supplemental hospital and doctor insurance plans? Get more plan details now, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

What are WORx benefits, and why might I need them?

WORx is an acronym for “Wellness, Office visits and Rx” (which itself is short for prescription drugs). These benefits focus on everyday health care services you might need.

In the wellness category, the WORx plan may cover some or all of these services (limits apply):

• Annual wellness exams
• Bone density scans
• Colonoscopies
• EKGs and stress EKGs (electrocardiograms, which can test you for heart conditions)
• Health screening labs
• Mammograms
• X-rays

Whether you have coverage for all these services depends on the plan option you choose, as well as your age and gender. Note that there’s a 30-day waiting period in most states before you can use your wellness benefits.

In the office visits category, the WORx plan covers a certain number of visits with doctors and specialists each year, depending on the plan option you choose. In the prescription category, the plan covers a certain number of prescriptions each year, depending on the plan option you choose.

Regardless of your plan option, you also get your yearly physical exam covered, as well as Pap smears for adult women, prostate-specific antigen (PSA) tests for men ages 40 and over, and allergy treatments for children. These services are limited to a certain number per calendar year.

What are my WORx plan options?

If you’re interested in exploring an HPG plan, there are 3 coverage levels:

1. WORx 1
2. WORx 2
3. WORx 3

As you move from WORx 1 to WORx 3, your premium increases and your benefits get more generous. A WORx 1 plan will cover 4 doctor office visits at $80 per visit. A WORx 2 plan will cover 5 doctor office visits at $100 per visit. And a WORx 3 plan will cover 6 doctor office visits at $125 per visit.

Read the insurance brochure before buying a plan, because not all the services listed above are covered. For example, WORx 1 does not cover x-rays. Neither WORx 1 nor WORx 2 covers bone density screenings, EKGs or stress EKGs. And WORx 3 covers all of the benefits listed above. In addition, exclusions and limitations are outlined in the brochure.

What are my hospital benefits, and why might I need them?

The hospital part of hospital and doctor insurance covers a range of services you might receive if you have to go to the hospital or be admitted for a period of time. Here’s a sample of the services that are covered (limits apply):

• Ambulance transportation
• Emergency room treatment
• Inpatient hospital stays
• Outpatient chemotherapy
• Outpatient labs, x-rays and other diagnostic testing
• Surgical procedures

The plan brochure details the services and how much the plan pays. For example, depending on your plan option, the plan would pay $1,000 to $5,000 per day for an inpatient hospital stay and $500 to $1,000 per ground ambulance trip (for up to 2 trips per year).

What are the hospital benefit plan options?

For those who are more concerned with the hospital side of hospital and doctor insurance, with an HPG plan, you’d have 4 options to choose from. Those include:

1. Choice
2. Select
3. Preferred
4. Premier

As you move up this scale, your premium increases but you get more services. For example, if you’re injured or sick and have to stay in a hospital for an extended period of time, a Choice plan will get you $1,000 a day, a Select plan $2,000 a day, a Preferred plan $3,000 a day, and a Premier plan $5,000 a day.

Be sure to read the hospital and doctor brochure carefully to see what each plan covers and what it pays for each type of service as well as limitations and exclusions that apply. When you combine all of the WORx and hospital benefit options, you have 12 different plans to choose from.

Which WORx and hospital benefits options should I choose?

Clearly, hospital and doctor insurance offers multiple plan options. How do you know what type of WORx and/or hospital benefits you’ll need? That depends on how you plan to access your health care and which health care services you think you’ll need.

“I usually tell my clients to buy the best coverage they can afford, particularly for the hospitalization benefit,” says Henson.

You can also think about it from a budgeting perspective. How much money do you need to have in your bank account to cover certain out-of-pocket expenses? Or as Trout puts it: “Essentially, what’s your pain threshold?”

Do I have to use a network provider for hospital and doctor insurance?

No. However, your total costs will be cheaper if you use a provider in the UnitedHealthcare Choice Plus network. In fact, the national estimated network discount is more than 56%. You may also need to stay in the network to get the most coverage from your main insurance plan. HMO (Health Maintenance Organization) plans require you to stay in network for coverage, while PPO (Preferred Provider Organization) plans have lower cost-sharing amounts if you stay in network.

By the way, the Choice Plus network is one of the largest ones in the United States. It includes more than 7,000 hospitals and facilities and 1.5 million physicians and health professionals. There’s a good chance the doctors and facilities you use are already included in the network.

Are virtual visits covered by hospital and doctor insurance?

Yes. UnitedHealthOne gives you access to telehealth services through HealthiestYou by Teladoc. You can meet with a doctor by phone or video at no extra charge. Doctors are available 24 hours a day, 7 days a week, all year long, and they can often prescribe medications virtually. Have questions about telehealth? Explore your options now, or contact a licensed insurance agent at 1-844-211-7730.

For an additional fee, you can also have a virtual visit with a psychiatrist, psychologist or dermatologist.

“I’ve personally used virtual medical visits several times while traveling, before they became popular with mainstream medical plans due to COVID-19,” says Henson. “Virtual visits, however, are best when dealing with a short-term illness or injury rather than a chronic condition.”

Is hospital and doctor insurance renewable?

Yes. Unlike with short-term insurance, you can renew your hospital and doctor insurance plan until you turn 65 — or until the next premium due date, depending on the state. After you turn 65, coverage can continue for the covered person’s spouse, if they’re under the age of 65, and/or children (or other dependents) who are covered under the plan.

Note that the coverage may be terminated if:

• You ask to cancel your policy
• You commit fraud or misrepresent information about your health status
• You don’t pay your premium

If you stick with the HPG plan, your benefits will get better starting in the second calendar year (after at least 6 months of coverage). The daily hospital benefit doubles, and you get 2 more doctor visits and 5 more prescription refills annually.

How old do I need to be to purchase a hospital and doctor insurance plan?

In most states, you and your spouse (if they’re on the HPG plan) must be between 18 and 64. You automatically drop off the plan when you turn 65. Children on the plan are eligible at birth and will drop off when they turn 26 in most states.

How much does hospital and doctor insurance cost?

Your monthly premium very much depends on who you are and how much coverage you need. Factors could include:

• Age
• Sex
• What plan options you choose
• Whether you smoke
• Where you live

You can find out more about what hospital and doctor plan works best for you by browsing plan options now or calling a licensed insurance agent at 1-844-211-7730 to discuss your options.

Does hospital and doctor insurance guarantee me coverage?

No. This plan is subject to medical underwriting. That means UnitedHealthcare will review your health history before approving your application. You might be denied coverage if you have a preexisting condition such as type 2 diabetes.

Does hospital and doctor insurance cover preexisting conditions?

Because hospital and doctor insurance requires medical underwriting — this isn’t such a cut-and-dried answer. In most states, hospital and doctor insurance doesn’t cover an illness, injury or condition if:

• The covered person received (or was recommended to receive) medical advice, diagnosis, care or treatment within the 12 months before the effective date of their coverage
• The covered person had symptoms that would cause an ordinarily prudent person to seek diagnosis or treatment within the 12 months before the effective date of their coverage

The preexisting condition limitation no longer applies after 12 months on the plan (or as required by state law).

Are there other exclusions I should know about?

Yes. Among other things, hospital and doctor insurance also doesn’t cover:

• Cosmetic treatments
• Experimental or investigational treatments
• Infertility treatments
• Injury while on active service in the armed forces or auxiliaries
• Injury while under the influence of controlled substances
• Injury while engaged in an adventure sport such as bungee jumping or skydiving
• Pregnancy or childbirth (except for pregnancy complications or as required by state law)

See the plan brochure for complete details.

Is hospital and doctor insurance available in my state?

In the case of UnitedHealthOne, hospital and doctor insurance is only available in 37 states. To see if your state is on the list, visit this page.

Does UnitedHealthOne’s hospital and doctor insurance work the same in every state?

Hospital and doctor insurance is significantly different in California and Oregon. In most of the other 35 states where the plan is available, you’ll find some variations too. Many of these relate to exclusions, eligibility and preexisting conditions. See the plan brochure for details.

“In my experience of working with clients in dozens of states, I do see pretty significant variations in monthly premiums [up to 25%], but not a significant difference in benefit offerings, assuming the plans are offered in a given state,” says Henson.

You can learn more about the state variations of hospital and doctor insurance by browsing hospital and doctor plan options online or by calling a licensed insurance agent at 1-844-211-7730 to discuss your options.

Sources:

HealthCare.gov. “What Marketplace health insurance plans cover.” Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover Accessed February 20, 2024

UnitedHealthcare. “About us.” Retrieved from https://www.uhc.com/about-us Accessed February 20, 2024

UnitedHealthcare. “California Health ProtectorGuard.” Retrieved from https://www.uhone.com/api/supplysystem/?FileName=47664CA-G202205.pdf Accessed February 20, 2024

UnitedHealthcare. “Find health plans in your state.” Retrieved from https://www.uhone.com/health-insurance-plans-by-state Accessed February 20, 2024

UnitedHealthcare. “Health ProtectorGuard.” Retrieved from https://www.uhone.com/api/supplysystem/?FileName=46034B-G202211.pdf Accessed February 20, 2024

UnitedHealthcare. “Hospital and doctor insurance — fixed indemnity plans.” Retrieved from https://www.uhone.com/health-insurance/supplemental/hospital-and-doctor-insurance Accessed February 20, 2024

UnitedHealthcare. “Oregon Health ProtectorGuard.” Retrieved from https://www.uhone.com/api/supplysystem/?FileName=45173OR-G202108.pdf Accessed February 20, 2024

Compliance code:
50759-X-0524