What is health insurance?
by Admin
Posted on 27-07-2022 03:14 PM
Health
insurance
is a contract between you and your insurance company/insurer. When you purchase a plan, you become a member of that plan, whether that’s a medicare plan , medicaid plan , a plan through your employer or an individual policy , like an affordable care act (aca) plan. There are many reasons to have health insurance. One reason is that it may give you peace of mind that you’re covered in case unexpected medical expenses happen. Knowing the details of how health insurance works can be an advantage when you’re deciding which plan is right for you.
Learn more about how insurance works.
Each year you'll pay your deductible. You'll pay for any services or supplies, when you check out, until you've met your deductible for the plan year. Each year you'll pay your coinsurance. After you meet your deductible, then you pay part of the bill (say 20%) and your insurance pays part of the bill (say 80%) until you've paid your coinsurance for the plan year. Your deductible + coinsurance = your out-of-pocket maximum (together, this is the most you'll pay during the plan year. )finally, your insurance starts paying 100% of your health bills until the plan year ends or you change insurance plans.
There are many different health plans out there, but once you understand the main types of health insurance and everything will be less overwhelming. Understanding the different types of health insurance is the first step to finding an affordable health plan. The first way you can define a type of health insurance is based on whether it’s public or private, like whether the coverage comes from a government-funded program or is partially paid for through your employer. The next most common way to categorize a health insurance coverage is plan type — how its structured and how its provider network is run.
Your premium, or how much you pay for your health insurance each month, covers some or all of the medical care you receive — everything from prescription drugs and doctors’ visits to health improvement programs and customer service. Most people choose a health insurance plan based on monthly cost , as well as the benefits and medical services the plan covers. But there are other factors to consider as well, like what you will be required to pay when you see a doctor or visit a health care facility. These out-of-pocket payments fall into various categories and it’s important to know the differences between them:.
How does health insurance work?
Health insurance can be tricky to navigate. Managed care insurance plans require policyholders to receive care from a network of designated healthcare providers for the highest level of coverage. If patients seek care outside the network, they must pay a higher percentage of the cost.
In some cases, the insurance
company
may even refuse payment outright for services obtained out of network. Many managed care plans—for example, health maintenance organizations (hmos) and point-of-service plans (pos)—require patients to choose a primary care physician who oversees the patient's care, makes recommendations about treatment, and provides referrals for medical specialists. Preferred-provider organizations (ppos), by contrast, don't require referrals but do have lower rates for using in-network practitioners and services.
An out-of-pocket maximum is the most you will have to pay for your health care expenses during a plan period (usually a year) for covered services received from providers that participate in the plan’s network. No matter what, you will not pay more than this maximum amount in a given year. Any care you receive for covered services after you meet your out-of-pocket maximum will be covered 100 percent by your insurance company.
Published: dec 02, 2014 health insurance explained – the youtoons have it covered is a light-hearted treatment of a difficult and important topic, breaking down insurance concepts, such as premiums, deductibles and provider networks. It explains how individuals pay for coverage and obtain medical care and prescription drugs when enrolled in various types of health insurance, including hmos and ppos. Written and produced by the kaiser family foundation. Narrated by former u. S. Senate majority leader bill frist, a nationally-recognized surgeon and foundation trustee. Creative production and animation by free range studios. The video is also available in spanish. If you would like to share the video with audiences offline, you may request to download the video by filling out the form below.
Deductible: the amount you owe for covered health care services before your health insurance or plan begins to pay. Copayment: an amount you pay as your share of the cost for a medical service or item, like a doctor's visit. Coinsurance: your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service. Premium: the amount you pay for your health insurance or plan each month. Network: the doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members.
What are the different types of health insurance?
Health care in the united states can be very expensive. A single doctor’s office visit may cost several hundred dollars and an average three-day hospital stay can run tens of thousands of dollars (or even more) depending on the type of care provided. Most of us could not afford to pay such large sums if we get sick, especially since we don’t know when we might become ill or injured or how much care we might need. Health insurance offers a way to reduce such costs to more reasonable amounts. The way it typically works is that the consumer (you) pays an up front premium to a health insurance company and that payment allows you to share "risk" with lots of other people (enrollees) who are making similar payments.
Similar to a catastrophic plan, you may be able to pay less for your insurance with a high-deductible health plan (hdhp). With an hdhp, you may have: one of these types of health plans: hmo, ppo, epo, or pos higher out-of-pocket costs than many types of plans; like other plans, if you reach the maximum out-of-pocket amount, the plan pays 100% of your care. A health savings account (hsa) to help pay for your care; the money you put in an hsa is not taxed and can be used tax-free on eligible medical expenses . In order to have a hsa, you must be enrolled in a hdhp.
Health insurance explained – the youtoons have it covered is a light-hearted treatment of a difficult and important topic, breaking down insurance concepts, such as premiums, deductibles and provider networks. It explains how individuals pay for coverage and obtain medical care and prescription drugs when enrolled in various types of health insurance, including hmos and ppos. Written and produced by the kaiser family foundation. Narrated by former u. S. Senate majority leader bill frist, a nationally-recognized surgeon and kaiser family foundation trustee. Creative production and animation by free range studios. Resource type .
Health insurance helps you stay well and cover your costs when you’re sick or injured. But what do the particular words used by insurance companies and providers mean? to help you get a deeper understanding, we’ve provided simple explanations of the most commonly used terms, below. Premium: like auto and home insurance, health insurance requires you to provide a payment each month to make sure your coverage isn’t interrupted. This is called a premium. The size of your premium varies based on your choice of plan and usually resets every year. Cost sharing: this general term refers to medical or pharmacy expenses you and your insurer pay together.
Health insurance open enrollment
When you are hired, ask about your deadline for enrolling in your employer's health insurance. After this deadline, you must usually wait until the yearly open enrollment period to join. However, you can enroll dependents after certain events, such as marriage, birth, or when your spouse or partner loses their job. The open enrollment period is when you make decisions about the insurance choices your employer offers. Your employer will tell you when insurance choices, benefits, and costs change. Self-insured plans many large employers are self-insured. The employer sets aside a pool of money and uses it to pay for the health care of employees.
On the type of health insurance you are looking for and other relevant circumstances in your life, you may be able to buy health insurance at any point in the year, or you may have to wait until the open enrollment period , which is the annual period when you can enroll in aca major medical health insurance plans. Open enrollment periods may vary by state, so check out the full list of open enrollment periods by state to see when you’ll be able to find an aca plan. That being said, if you experienced a qualifying life event (loss of employer-sponsored health insurance, divorce, relocation to a new coverage area, etc.
The affordable care act (aca), also called obamacare or bidencare, was put in place to help make health insurance easier for people to get. Marketplace (aca) plans are sold on the health care marketplace, or exchange. They focus on preventive care, cover pre-existing conditions, and provide benefits for things like doctor visits, prescriptions and lab tests. If you're looking for marketplace coverage, you usually need to enroll during the established enrollment period. Check into unitedhealthcare individual and family marketplace plans to find a variety of affordable, quality coverage options. Learn more about unitedhealthcare individual and family marketplace plans.
A time outside the open enrollment period during which you can sign up for health insurance. You generally qualify for a special enrollment period of 60 days following certain life events that change your family status (for example, marriage or birth of a child) or loss of other health coverage.