Understanding Health Insurance: Are You Covered?

understanding health insuranceTaking care of yourself and your family can be an expensive task even when you’re all healthy.  If illness strikes, the costs could increase dramatically and it can be financially devastating for an individual or family.  Having health insurance coverage helps to alleviate some, or most, of the financial concerns that may come up if you, or a relative is sick or hurt.  By estimating the overall risk of incurring medical expenses among a group of individuals insurance companies are able to develop a cost structure that is then broken down into premiums that the insured individual will pay to maintain their coverage.  According to the Health Insurance Association of America, health insurance is defined as “coverage that provides for the payments of benefits as a result of sickness or injury.  Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment”.  To learn more about health insurance, how it works, and what it is, enroll in our Basics of Health Insurance course for an overview.

There have been many changes to health insurance requirements due in part to the Affordable Health Care Act.  Previously insurance carriers could deny you coverage if you had a pre-existing medical condition.  This made it tougher for some to maintain or change their health insurance carriers and could have an impact on the amount of money that was required to maintain their insurance policy.  The Affordable Health Care Act has helped to alleviate this problem.  Regardless of where you buy your plan, whether it be from an insurance broker, your states health insurance marketplace, or if you work for a small company that provides it as part of your benefit package at work; insurance which is now sold to people and small business must now cover these ten health benefits.  Emergency services, hospitalization, laboratory tests, maternity and newborn care (did you know that the cost of having a baby in a hospital is about $3500.00 and that doesn’t include pre and post natal care), mental health and substance understanding health insuranceabuse treatment, outpatient care, pediatric services, prescription drugs, preventative services, and rehabilitation services.  Having a baby soon?  Join other expectant parents who want to prepare for their little bundle and enroll in our Bringing Baby Home course to learn some basics.

Since insurance could have such a significant impact on your families health and finances it’s important to review a few key items before going out and purchasing a health insurance plan.

Am I Covered

We’ve gone over some of the requirements that have been imposed on health insurance companies by the new Affordable Care Act.  When shopping for a plan though, you must still confirm that the plan will meet all of your health care needs.  Be sure to ask for a Summary of Benefits and Coverage that will detail exactly what the plan does and does not cover.  You want to make sure what you’re getting for the money that you’ll be putting out.

How Much Will I Pay for Coverage

understanding health insurancePlan premiums will depend on a variety of factors.  It’s important to know what those factors are and if any of them can be changed to reduce your premium amount.  There are usually two amounts that you will pay to have medical insurance coverage.  A Monthly Premium which is the amount that you have agreed to pay to purchase your insurance plan and an out of pocket expense.  Out of pocket expenses are considered to be any deductibles, co-payments or co-insurance expenses that have to be paid when you use your medical insurance.  These will both vary based on your selected plan.  If you just don’t think that you have the room in your budget for an added expense, you should check out your states Health Insurance Marketplace.  You may be eligible for income based subsidies that would reduce the cost of your premium.  If you don’t qualify for the income based subsidies then it may be time to re-evaluate your budget.  Budgeting 101 will help you set up a budget plan and help you stick to it.  You may be able to reduce your out of pocket expenses by paying a higher insurance premium.  Car insurance works in much the same way.  The higher that your insurance premium is, the lower your deductible is when you are involved in an accident and need to file a claim.  The adverse holds true as well, you can save money upfront and pay a lower premium.  But, if you are involved in an accident and need to file a claim your deductible will tend to be higher.

Can I Keep My Doctor

understanding health insuranceSwitching insurance plans can already feel like an overwhelming and scary issue for a lot of people.  It’s only compounded when you realize that your new insurance plan may not be accepted by the doctor you and your family have visited for years.  When purchasing an insurance plan it’s important to check which doctors and hospitals are included in their list of accepted providers.  If you visit your doctor without checking first to see if they are on the list of approved providers, and it turns out that they’re not, your claim may be denied and you could potentially end up footing most, if not all, of the bill.  So, if you really want to stick with your current doctor, make sure that you confirm with the insurance company and the doctors billing department that they contract with the insurance company you are selecting and take the form of insurance you will have.  This simple step could save you lots of unnecessary stress and money.

If your doctor is not covered, ask them if they can recommend a doctor that will be in your network.  There are also websites that may offer patient reviews of doctors in your area.  Reach out to friends and family to see if they have a family doctor in the area that is accepting new patients.

Although the idea of health insurance may seem scary and overwhelming, it’s really not.  Take the time to educate yourself and understand what you are purchasing.  After all, isn’t your health and the health of your family worth investing in?