Health insurance coverage can help make sure that a medical emergency doesn’t turn into a financial one. But if you’re unfamiliar with the many terms and conditions of your health insurance policy, it can be difficult to know what is covered and what is not. And that’s why we’re here to help make sense of it all.
When you understand what’s covered and what you’re expected to pay, you can make informed decisions about your care. Stay with us as we tackle the ins and outs of health insurance benefits, from what’s covered in your policy to what you’ll be expected to pay.
Before the Affordable Care Act (ACA), also known as Obamacare, insurers could deny coverage to people who had pre-existing medical conditions or used too much medical care.
Now, all ACA-compliant health plans must meet minimum essential coverage standards, such as covering preexisting conditions, providing essential benefits, and offering preventive care at no cost before you meet your deductible.
This means that regardless of your health condition or which plan or provider you choose, your insurer must help pay for certain medical services, known as essential benefits. Here is a list of those essential benefits that must be covered in every ACA-compliant plan:
It’s important to know that while you can buy some non-ACA-compliant short-term insurance plans (less than 12 months), they may have more exclusions and fewer benefits.
Health insurance plans are filled with unfamiliar terms and phrases, and if you don’t have a good grasp of their meaning, you could be caught off guard with some unexpected expenses.
Understanding the fine print of your coverage is essential for making the right health care choices for you and your family. Here’s a closer look at some of the most common health insurance terms you should know:
When you have coverage from more than one health plan (also known as dual coverage), state law allows your insurance company to follow a procedure called “coordination of benefits”. This will determine how much each should pay when you have a claim. The goal of coordination of benefits is to ensure that the combined payments of both plans do not add up to more than your covered health care expenses.
If a person is covered under two health insurance plans, they stand to gain because where the primary carrier stops paying, for example with a co-insurance clause, then the secondary carrier may step in and pay the difference. This could leave the enrollee with nothing to pay.
Your co-pay is typically different for different types of services, including primary care vs. specialty care, and it’s most commonly associated with doctor visits and when purchasing prescription medications.
However, co-payments do not usually apply to all services covered by a health care plan. That makes it important to understand the details of your policy, so that you know what costs you will be expected to pay in full and which you will pay for only partially.
Low-deductible plans make managing and predicting health care expenses easier since you won’t have to worry about out-of-pocket expenses that you can’t afford. This could be especially helpful in the event that you need surgery or develop a serious illness. The only drawback is that if you don’t end up needing extensive medical care, you will have paid a higher monthly premium than necessary. A low-deductible plan is a smart choice for the following circumstances:
The good news is that most insurance plans set an out-of-pocket maximum, which is a limit on the amount of money you have to pay for covered health care services in a plan year. Once you meet your deductible, your plan will start to pay its share of health care costs for the rest of the plan year. If you have dependents on your plan, you could have individual out-of-pocket maximums and a family out-of-pocket maximum. This depends on the terms of the plan.
Health insurance policies can be confusing, but we’re here to help make it as easy as possible—which includes giving you some of the best coverage rates in the industry. Our online health insurance quotes are fast and—best of all—free! Get yours today and say hello to affordable healthcare coverage that’s comprehensive and affordable.