Health Insurance

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What is Health Insurance?

Health insurance is a contract that requires an insurer to pay some or all of a person’s healthcare costs in exchange for a premium. More specifically, health insurance typically pays for medical, surgical, prescription drug, and sometimes dental expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly.

How does health insurance work?

Health insurance works to help lower the amount you would otherwise have to pay for high cost medical care. This is typically how a health plan works, but they can vary:

You pay a premium—usually monthly. This is a fee for having the health plan.
Most health plans have a deductible. A deductible is how much you must pay out of your pocket for care until your health plan kicks in to share a percentage of the costs.
Once you meet your deductible and your plan kicks in, you start sharing costs with your plan. For example, your health plan may pay 80% of your medical costs and you may pay 20%. This is called, “coinsurance.” Most insurance ID cards show your deductible and coinsurance.
Preventive care is typically covered 100% This includes things like your annual check-up, a flu shot, vaccinations for kids, certain wellness screenings, and more. (Some plans may require a copay—a small fee you pay at the time of the doctor visit).
You save money when you stay in-network. Network providers agree to give lower rates to the insurance company’s customers. You can usually find a list of network providers on your health insurance website, or by calling and asking them for a list of in-network providers. This is a key part of how health insurance works to help keep your costs low.
Your health insurance may also come with extra no-cost programs and services. This may include health and wellness discounts for services and products, incentive programs where you can earn cash awards and other prizes for completing healthy activities, and more.

Why You Need Health Insurance

Health insurance is necessary for Americans to pay for the high cost of healthcare. You generally need it unless you can afford to pay for healthcare on your own or receive government assistance. The very wealthy can afford the cost of even extraordinary emergency or chronic medical care. Those over age 65 usually qualify for Medicare. Lower-income individuals and families may qualify for Medicaid.

Everyone else must either purchase health insurance or risk medical bankruptcy. Since it is so common, many people have lost sight of its underlying purpose. It’s just like insurance for your car, home, or apartment. It’s supposed to protect your life savings from the devastating costs of a major accident, medical emergency, or chronic disease.

Unlike other insurance, health insurance makes it possible for you to get healthcare when you need it. If you don’t have car insurance, you can take the bus until you can afford to get your car fixed. If you break your leg, you can’t splint it yourself until you save up enough to go to the doctor.

How To Choose Health Insurance

Health insurance companies provide lots of choices, options, but before you select a plan, you’ve got to wade through various combinations of deductibles, copays, coinsurance, and premiums.

Monthly premiums. Like auto or homeowners insurance, you pay this even if you never make a claim. That provides the cash flow so insurance companies can pay their day-to-day expenses.
The deductible. That’s what you pay before the insurance company contributes a dime. It is an annual amount, which means you start over on Jan. 1 of each year if your plan has a calendar-year policy. Plans that renew at other times of the year might not follow the calendar year for resetting the deductible period.
A copay for each visit. A typical copay might be $20 for a doctor visit, $50 for a hospital visit, and $10 to $40 for each prescription. You pay 100% for the visit until the deductible is met.
Coinsurance. That’s a percent you pay for procedures, like surgeries, or hospital stays. If your doctor visits you in the hospital, you might pay a copayment for the visit and coinsurance for the hospitalization.

Why Health Insurance Is Important

No one plans to get sick or hurt, but most people need medical care at some point. Health Insurance covers these costs and offers many other important benefits. Health Insurance provides important financial protection in case you have a serious accident or sickness. People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.

Health Insurance is a good way to help you manage your health care costs. You pay health care companies premiums – a set amount of money each month – and you get benefits to pay for your eligible health care expenses. This can include regular
doctor checkups or injuries to treatment for long-term illnesses.

You Can Purchase Individual Health Insurance Through The Health Insurance Marketplace On Your Own. Even Though It’s Called Individual Health Insurance, You Can Also Find Plans To Cover Your Family. Because Health Care Can Be Expensive, It’s A Smart Idea To Have Health Insurance So You’re Prepared For When You Or Your Family Have Medical Needs.

Individual Health Insurance

Choosing Individual Health Insurance Is Going To Be A Balancing Act Between Cost And Coverage, As Well As your Philosophy Of Care. Finding The Right Balance Of Coverage And Cost Can Be Tough, But It’s A Necessity. So Take Your Search One Step At A Time. The First Step Is To Evaluate Your Needs And Understand Your Health Insurance Options. Among Your Choices, You’ll Find That The Individual Health Market Offers The Same Plans As The Group Market, Including HMOs, PPOs, Point-Of-Service Plans And Traditional Fee-ForService Arrangements. Your Budget, Physician Preferences And Health Requirements Will All Have A Hand In Deciding Which Type Of Plan Is Best For You

What does health insurance cover?

Health insurance plans may cover a wide range of medical care and services. These often include preventive and non-preventive care, as well as emergency care, behavioral health, and sometimes vision and hearing.

What you pay out-of-pocket and what your plan helps pay for can depend on a number of factors. These factors include whether you’ve met your deductible, what your coinsurance is, if you are getting care from in-network providers and facilities, if your care is preventive or not, and more.

Here are examples of health insurance benefits your plan may cover:

Preventive visits: Things like an annual check-up (adult or child), are typically covered 100%.
Vaccinations: Some vaccinations are covered 100%, too. For example, many plans pay for an annual flu shot and certain kinds of childhood vaccinations.
Non-preventive doctor visits: For in-network doctors and specialists you get a reduced rate as part of the network. Your plan helps pay its share of the cost once you’ve met your deductible.
Hospitalization: Your plan helps pay its share of the cost once you’ve met your deductible. You will pay less if you go to a hospital that’s in your plan’s network, if required.
Emergency Room: Many health plans do not require you to go to an in-network ER in an emergency, but plans can differ.
Lab work: If you go to an in-network lab, your costs for lab work will be lower. Your health plan negotiates lower rates with them, too.
Additional, or supplemental coverage that’s added to your health plan: Coverage for cancer care, accident coverage, and more can help you pay for care that’s often costly and unexpected.

What does health insurance not cover?

What’s not covered by health insurance can also vary depending on the plan. Here are some types of services that are not typically covered:

Alternative medicine—such as massage, acupuncture, herbal healing, and more.
Cosmetic surgery—things like plastic surgery, laser skin removal, liposuction, rhinoplasty (nose job), etc.
Weight loss surgery—things like gastric bypass and bariatric surgery may not be covered. This depends on the plan you get, though. Some procedures may be covered, if medically necessary, so check your plan documents carefully.
Vein surgery—laser surgery to correct spider veins is often considered cosmetic and may not be covered unless a doctor can show it’s medically necessary.
Elective surgeries—especially surgeries that a doctor cannot prove a medical need for.
Unapproved medical care—if you fail to get a required precertification for care or a service, your health plan may deny you coverage. Precertification is pre-approval from your health insurer. Many health plans require this type of pre-approval for certain types of procedures or treatments.
Experimental treatments or procedures—for example, surgeries that use new technology or methods that may not have proven outcomes.

Your Summary of Benefits Coverage (SBC) document that comes with your health plan will itemize the care and services covered, as well as what’s not covered. When you know how your health plan works, you are better able to avoid paying unnecessary out-of-pocket costs.

What are the benefits of having health insurance?

The benefits of health insurance include:

Lower out-of-pocket costs for care since it’s shared with your health plan.
$0 preventive care—annual check-ups, routine health screenings (mammogram, colonoscopy, cholesterol screening), and certain vaccinations are fully paid for by your health plan. This means getting routine care costs you nothing. If you had to pay for this on your own, you’d pay hundreds of dollars out of your own savings each year, or you’d make decisions not to go to the doctor, with possible impacts to your own and your family’s health.
Coverage for unexpected costly medical care, such as hospitalization and care for a serious illness like cancer, or in the event of an accident or serious injury. That’s not to say there is no cost to you, but once you meet your deductible, your plan helps pay a large share of the cost. If you hit your annual out-of-pocket maximum (the most you need to pay in a year) then your plan starts paying for all of your care.
Peace of mind—having a health plan may give you some comfort in knowing that there is a limit to how much you need to pay out-of-pocket for costly medical care. In addition, since your health plan pays most preventive care, you can also have the peace of mind that you and your family can get all your routine care, with little to no additional cost. (Some plans may require a small copay at the time of a visit).

Get A Health Insurance Plan

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