The Ultimate Guide to Understanding Health Insurance
The Importance of Health Insurance
The U.S. spends more on health care than any other country in the world, and yet it has some of the worst health outcomes. The high cost of healthcare is due to a complex mix of factors such as our for-profit insurance system, our fragmented delivery system, and lack of universal coverage.
f you are lucky enough to have employment-based health insurance or Medicare through Social Security then you may not need this article — but if you do purchase your own plan (or don’t know where else to turn), or you want to opt for Humana Medicare Supplement plan, understanding how those plans work can help make sense out all the options available today! Health policies come with various degrees of “coverage” – from catastrophic coverage, to major medical coverage and even dental.
Let’s take a look at the four key components that make up any health insurance plan: deductible, co-insurance, out-of-pocket maximums (OOP), and provider network. For example: A deductible is what you pay before your insurer will start paying for covered services like doctor visits or prescription drugs…
Co-insurance means the amount you will contribute to a medical charge or bill.
Out-of-pocket maximums are the most you can pay for in expenses per year before your insurer steps in and covers 100% of any additional out-of-pocket costs…
Provider networks mean which hospitals, doctors, and specialists they cover (doctors outside your network may not always be covered).
The Affordable Care Act means that all plans must include ten essential benefits – such as mental health care, maternity coverage, or prescription drugs while “grandfathered” plans remain unchanged until 2020. A high deductible plan is one with lower monthly premiums but higher deductibles before the policy pays for anything including co-insurance or out-of-pocket maximums.
…
