Health insurance is a plan or policy that covers a percentage of doctors’ visits and hospital bills. It exists to help offset the costs of medical events, whether they’re planned or happen unexpectedly. Health insurance may also protect individuals when they’re feeling good and may help keep them feeling that way through wellness programs and preventive care .
How does health insurance work?
Health insurance works by providing coverage for medical expenses. When an individual has health insurance, they typically pay a monthly premium to the insurance company. In return, the insurance company helps cover the costs of medical services, such as doctor visits, hospital stays, and prescription medications. The specific coverage and costs depend on the insurance plan and its terms and conditions .
Choosing a health insurance plan
When choosing a health insurance plan, there are a few key factors to consider:
Metal categories
: Health insurance plans are often categorized into Bronze, Silver, Gold, and Platinum categories. These categories indicate how individuals and their insurance plans share costs. It’s important to note that plan categories have nothing to do with the quality of care .
Total costs for health care
: In addition to the monthly premium, individuals may have to pay out-of-pocket costs when they receive medical care. It’s important to consider both the premium and the out-of-pocket costs when comparing plans .
Plan and network types
: Different plan types have different networks of doctors and healthcare facilities. Some plans allow individuals to use almost any doctor or healthcare facility, while others have more limited choices or charge more for out-of-network providers .
Understanding your health plan
To fully understand your health plan, it’s important to know the following:
Benefits and exclusions
: Not all health plans cover the same services in the same way. It’s essential to review your insurance policy to understand what services are covered, any limitations or maximum amounts for certain services, and what services are not covered .
Accessing services
: Your health plan may have specific requirements for accessing services. This can include using network providers, obtaining authorization before seeing a provider, and knowing what to do in case of emergencies or hospitalization.