Health insurance helps you pay for medical care, prescriptions and other services. It also protects you against unexpected costs.
How much it costs depends on a variety of factors, including your age, income level and the type of plan you have.
Plans can include a network of doctors and hospitals that the insurer negotiates lower rates with. They may also have a deductible and co-payments.
Costs
Health insurance can be a significant monthly expense, but it also provides important financial safety nets to help you cover unexpected medical costs. Having health insurance can save you thousands of dollars if you suffer from a serious illness or injury.
Premiums for individual and family coverage vary based on age, zip code, tobacco use and the type of plan you choose (different insurers offer similar plans with different premiums). Income can also help lower your premium.
Deductibles and copayments are another set of costs that you share with your insurance company when you get healthcare. These costs can range from $10 for a visit to a doctor’s office to 30% of the cost for a medical procedure.
The deductible is the amount you have to pay each year before your health insurance starts to cover a percentage of your healthcare expenses.Once you reach the deductible, you will need to pay copayments and/or coinsurance for each medical service that you receive.
Coverage
Health insurance is a contract between an insured person and an insurer that covers specific healthcare expenses. In return for a monthly premium payment, the insurer pays the insured individual for medical and surgical costs.
Coverage usually includes doctor and hospital visits, prescription drugs, wellness care, and medical devices. But some services, such as elective procedures and cosmetic treatments, are not covered by most health plans.
The plan you choose should have a deductible, copays, and coinsurance. These costs must be paid before your insurance company starts to pay for services.
Your insurance company will send you a document called an Explanation of Benefits (EOB) that outlines what is and isn’t covered. Read it carefully, and talk to an insurance professional to make sure you have the right coverage for you and your family.
Pre-existing conditions
Before the Affordable Care Act (ACA) was passed, it was common for health insurance companies to deny people coverage or charge them higher premiums due to their pre-existing conditions. However, since January 1, 2014, this type of discrimination has been prohibited by law.
A pre-existing condition is any medical problem or illness that you have had before the start date of your health insurance coverage. Examples include cancer, asthma, and diabetes.
The ACA prohibits all types of health insurance plans from denying or charging more money for people with pre-existing conditions, and it also protects those who are covered through Medicaid or the Children’s Health Insurance Program (CHIP). There are some exceptions to this rule. These include “grandfathered” individual market health plans that were purchased before March 23, 2010.
Exclusions
In health insurance, there are exclusions that can affect your coverage. These exclusions are typically listed in the policy document and should be read carefully before signing on the dotted line.
Pre-existing conditions: Any condition that you have had symptoms for or treatment for prior to the start date of your health insurance plan will usually be excluded from coverage. Some plans may include these conditions after a waiting period, but be sure to check the wording of your policy.
Chronic conditions: These are medical conditions that require long-term monitoring or have no known cure. Examples of these include diabetes, asthma and arthritis.
Cosmetic surgery: Many insurance policies exclude coverage for cosmetic surgery unless you have elected to add it to your plan.
Finally, pregnancy and childbirth costs are sometimes excluded from standard medical plans. However, if you are using a surrogate to get pregnant, this cost is covered by your insurance plan. Depending on the policy, it may also cover expenses associated with infertility or abortion.
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