What is Health Insurance?

A brief description of what health insurance is and how it works to keep your medical expenses down by covering the majority of your hospital bills for a low monthly payment.
What is Health Insurance?

Health insurance is a type of insurance coverage that helps pay for medical expenses. It can help protect you from unexpected and high medical costs, allowing you to get the care you need without having to worry about the financial consequences. Health insurance can provide access to preventive care like doctor's visits and vaccines, as well as cover hospitalizations, surgeries, and other treatments. Health insurance is essential for everyone – without it, it would be very difficult to afford quality healthcare.

Why Do We Need Health Insurance

The high cost of medical bills can add up, causing catastrophic financial debt. Major medical health insurance protects you from having to pay the full cost of health care. This provides financial protection against the high costs of medical treatment. Health care can consist of an annual checkup, a visit to the emergency room, or preventative care. How does this work? When you or your family sign up for a health insurance plan you will pay a monthly fee called a premium. Monthly premiums allow the insurance company to pay for a portion of your covered medical expenses. Each plan is going to differ, but most cover preventive care, doctor, hospital, and prescription drugs. You can choose a plan that best fits your medical needs and budget. Depending on your household income, you may qualify for financial assistance from the federal government. This will help lower your premium payments or to help with the out-of-pocket costs.

Who Needs Health Insurance?

Everyone needs health insurance, regardless of age or income. Insuring yourself and your family helps protect you financially against medical costs associated with serious illnesses, injuries or even just routine doctor visits. Health insurance is also an important factor when determining eligibility for financial assistance in the form of subsidies for those who purchase plans through the marketplace. For many people, health insurance can mean access to regular preventive care that could ultimately save them time and money over the long term.

Are Americans Required to Buy ACA-Compliant Health Insurance?

According to the Affordable Care Act (ACA), most Americans are required to have health insurance that meets certain standards. These standards include coverage of essential health benefits, limits on cost-sharing, and no pre-existing condition exclusions. Those who do not comply with this requirement may face a tax penalty, so it’s important to make sure your health insurance is ACA compliant.

How Does Health Insurance Work

Health insurance helps you pay for medical expenses, usually through monthly premiums. Depending on your coverage, the policy may cover a portion of your care costs after you meet certain deductibles or co-pays. Some plans may also include additional features like wellness visits and prescription drug coverage. Health insurers are required to provide customers with information on their coverage, as well as any changes to the plan that occur each year.

Health insurance works by charging a monthly premium to cover the costs of your care if and when you need it. Co-payments and deductibles apply as well, so it is important to understand how much money you need to pay for services upfront and whether or not reimbursement is available. For example, most health plans will require you to pay a set co-payment for doctor visits or prescriptions before the plan will cover the rest of the cost. In addition, the deductible is a set amount that must be paid before insurance coverage begins.

First things, you have to pay your premium every month or your insurance could get canceled. If you have insurance through your job it is likely your employer is paying most of your premium. Any remaining cost comes out of each paycheck.

Insurance is quite helpful when things go wrong, accidents do happen. Keep in mind insurance is very helpful but does not guarantee that all of your medical services will be at no cost. There are tons of aspects of your insurance plan that have an impact on how much you have to pay when you get sick or hurt. In most cases, you will probably need to pay when you visit the doctor or fill a prescription. This will be either a copay or coinsurance.

A copay (copayment) is a set dollar amount that you pay for a healthcare service such as doctor visits, prescription drugs, and urgent care. Coinsurance is the percentage that you and the insurance company share to cover medical expenses. These expenses can be emergency rooms, surgeries, lab tests, and certain treatments. Depending on your plan you may pay coinsurance upfront or pay toward your deductible first. A few examples would be 20% coinsurance for lab work. Another would be you pay 20% coinsurance after you meet your deductible.

What happens if you reach your deductible? After reaching your deductible the plan may require some form of coinsurance. As mentioned this is a fixed percentage and will go towards what is called a max out-of-pocket. For example, a plan may have a $1,000 deductible with a $6,000 max out-of-pocket. After reaching the max out-of-pocket of $6000 the insurance pays 100% of covered medical expenses.

For generally healthy individuals who experience an unexpected injury or accident, the out-of-pocket maximum offers a safety net. Health care costs can add up fast, so having a spending cap helps prevent you from experiencing massive expenses that could leave you in serious debt or force you into bankruptcy.

What Are The Different Types of Health Insurance?

There are many different types of health insurance, including traditional health plans, managed care plans, high-deductible health plans and short-term health plans. Traditional health plans typically cover a wide range of services and have relatively low out-of-pocket expenses, but premiums can be costly. Managed care plans include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), which often offer reduced premiums in exchange for using specific providers. High deductible health plans require a significant amount of money to be paid before coverage begins, but the premiums are typically lower than other types of insurance. Short term medical insurance is a limited duration policy usually purchased as interim coverage between other policies.

How to Keep Your Medical Costs Down

The cost (premium) for health insurance is a reflection of medical care. The more it costs to take care of an individual, the more the insurer has to charge all their subscribers. To combat this, health insurance companies typically provide preventive care to their subscribers. Doing this helps individuals to stay healthy and doesn't cost the insurance companies a ton of money.

How Much Does Health Insurance Cost?

The cost of health insurance depends on a variety of factors, including the type of plan selected, location and age. Generally speaking, plans with higher premiums provide more coverage while plans with lower premiums offer less coverage. Deductibles are generally lower on more expensive plans but may still require out-of-pocket costs that can add up quickly. Additionally, many employers offer employer contributions to help defray costs, as well as tax credits for individuals who purchase private health insurance. Ultimately, everyone's particular situation will dictate their individual cost considerations when it comes to selecting a health insurance plan.

How is Health Insurance Regulated?

Health insurance is heavily regulated by both state and federal governments. Insurance companies must be licensed to operate in each state, and must meet the requirements for coverage set forth by the relevant government agency. Insurance plans are monitored for solvency and compliance with insurance laws. Laws also exist to prevent discrimination in health insurance settings, such as prohibiting insurers from denying coverage based on pre-existing conditions. In addition, many states have enacted legislation that requires health plans to offer a certain level of coverage and to provide consumer protections related to premiums, claims processing, and more.

How to Get Health Insurance?

Getting health insurance can be a daunting task, but there are many options available. The most common way to acquire coverage is through an employer or through the government. However, for those without these options, it is possible to purchase insurance from private companies. Coverage Guru makes the process of finding and comparing health insurance plans much easier by providing quotes from multiple providers in one place. It helps you compare plans side-by-side and understand which policy best suits your needs based on factors such as deductibles, premiums, copayments and more.