How Health Insurance Works

In this post, we will help you understand how health insurance works in simple terms. We know the insurance world could be very confusing and when it comes to health insurance there’s no exception. Terms like premium, copays, out-of-pocket, deductibles and others can scare you away. But no worries, keep reading this article.

What is Health Insurance?

Health insurance is a contract between a health insurance company and an individual. The company agrees to pay all or some of the insured person’s covered medical services in exchange for a monthly payment or premium. In other words, it is a type of insurance that covers the cost of medical care. It helps to protect you and your family from the high cost of medical care and can help to pay for medical expenses such as doctor visits, prescription drugs, and hospital stays.

Here’s how it works:

1. You pay a monthly premium to your health insurance company. This is a fee that you pay to have health insurance coverage. The premium is typically paid on a monthly basis, although some health insurance plans may allow you to pay the premium on a quarterly or annual basis.
2. You may have to pay a deductible before your insurance starts to cover medical expenses. A deductible is a fixed amount that you have to pay out of pocket before your health insurance will start to cover your medical expenses. For example, if your deductible is $1,000 and you have a medical expense of $500, you will have to pay the full $500 out of pocket.
3. After you meet your deductible, your insurance will start to cover a portion of your medical expenses. The percentage of your medical expenses that your insurance will cover is called the “coinsurance.” For example, if your coinsurance is 20%, and you have a medical expense of $100, you will pay $20 (20% of $100) and your insurance will cover the remaining $80.
4. There may be a limit on how much your insurance will pay for medical expenses each year. This is called the “out-of-pocket maximum.” Once you reach this limit, your insurance will cover all of your medical expenses for the rest of the year.

It’s important to understand that health insurance plans can vary widely, so it’s a good idea to carefully review the terms of your plan to understand what is and is not covered. If you have questions about your health insurance, you can contact your insurance company or a licensed insurance agent for more information.

How can I get a Health Insurance plan?

The most common type of health insurance is through your employer. This is called group health insurance because it’s provided by an employer that offers coverage to all employees. Group health insurance can also be purchased directly from an insurance company, but the cost will likely be higher than if you get it through your employer. The problem is that not all employers offer health insurance options for their employees.

The second and most affordable option is by using the Healthcare Marketplace during the Open Enrollment period. This process allows you to apply for subsidies and other benefits if you are eligible for such. You can apply for a health insurance plan with the help of one of our health insurance experts or by visiting the marketplace by on your own.

Of course, our suggestion for you is to use an agent because they will be able to smooth the process and solve all your questions or doubts about every health plan available to you. And also help you register for a plan that meets your needs and budget. With us, this is a service free of charge to you.

SEE IF YOU QUALIFY FOR AN AFFORDABLE HEALTHCARE PLAN

What medical services are covered by a Health Insurance plan?

Health insurance plans typically cover a range of medical services, including preventive care, diagnostic services, and treatments for various health conditions. Some examples of the types of medical services that may be covered by a health insurance plan include:

• Primary care visits: These are visits to a primary care physician, such as a general practitioner, family doctor, or internist, for routine check-ups, health screenings, and treatment of common health issues.
• Specialty care: This may include visits to specialists, such as cardiologists, dermatologists, and neurologists, for more specialized medical care.
• Hospitalization: Health insurance plans typically cover the costs of staying in a hospital for medical treatment, including surgery, as well as costs for medications and other treatments received while in the hospital.
• Prescription medications: Most health insurance plans cover the cost of prescription medications that are prescribed by a doctor and filled at a pharmacy.
• Mental health and substance abuse treatment: Many health insurance plans cover the cost of mental health and substance abuse treatment, including therapy and counseling sessions, as well as medications.
• Rehabilitation services: Health insurance plans may cover the cost of rehabilitation services, such as physical therapy, occupational therapy, and speech therapy, to help individuals recover from injuries or surgeries.
• Preventive care: Health insurance plans often cover the cost of preventive care, such as vaccines, cancer screenings, and other tests that are used to identify and prevent potential health problems.

Keep in mind that the specific medical services that are covered by a health insurance plan can vary depending on the specific plan. It is important to carefully review your plan’s coverage details to understand what is covered and what is not.

What medical services are NOT covered by a Health Insurance plan?

While health insurance plans typically cover a wide range of medical services, there are some types of care that may not be covered. Here are a few examples of medical services that may not be covered by a health insurance plan:

• Elective procedures: Elective procedures are those that are not medically necessary, but are chosen by the patient for cosmetic or other personal reasons. Examples of elective procedures include plastic surgery, hair transplants, and laser eye surgery. These types of procedures are often not covered by health insurance plans.
• Experimental treatments: Health insurance plans may not cover experimental treatments that are still being tested or have not been proven to be effective.
• Alternative therapies: Some health insurance plans may not cover alternative therapies, such as acupuncture, chiropractic care, and naturopathy, which are not typically considered to be part of mainstream medical care.
• Long-term care: Health insurance plans may not cover long-term care services, such as nursing home care or in-home care for individuals with chronic health conditions.
• Dental and vision care: While some health insurance plans may include coverage for dental and vision care, these services are often not included in standard health insurance plans.

Again, it is important to carefully review your health insurance plan to understand what is covered and what is not. If you have any questions about your coverage, you should contact your insurance company or your employer’s human resources department.