Health insurance can be an overwhelming experience. There are various plans and coverages, as well as terms (and acronyms) to decipher, which add complexity. Furthermore, costs can quickly add up.
But don’t let it be intimidating; we are here to make the process simpler for you and understand concepts such as copays, deductibles and premiums.
What is health insurance?
Health insurance is designed to cover part or all of your health care costs in case of unexpected illnesses or injuries, including doctor visits, hospital stays, surgery procedures, lab tests and X-rays.
Examples of health care services covered by health plans may include preventive visits (like your annual check-up), treatment for an illness or injury, prescription drugs and wellness benefits such as annual screenings and counseling.
There are various kinds of health plans, and when selecting one for yourself and your family it’s essential to take into account both needs and budget. Plans typically feature both deductibles and copayments – with the former often required before benefits start covering services; copayments typically amounting to $15 when paying for doctor visits or prescription refills respectively.
Some employers opt not to purchase health insurance plans from private companies directly, instead using their own funds instead. These self-funded or employer-funded plans are known as self-funding or employer-funded plans and fall under the mandates of the Affordable Care Act; most groups must provide health coverage or face penalties from the Affordable Care Act. If your job or employer changes, COBRA coverage could help keep coverage intact if COBRA options become available; for those unemployed looking for low cost health care programs like Medicare or Medicaid as an option or purchase individual plans during open enrollment periods.
How does health insurance work?
Health insurance is an invaluable form of risk management, designed to offset the expenses associated with illness and injury. Most health plans offer monthly premiums in exchange for providing medical, surgical, pharmaceutical and preventive care expenses including doctor visits and screenings as well as preventative screenings and routine check-ups.
Many people gain health coverage through their employer or union; however, individual policies or the Affordable Care Act (ACA) also exist. No matter the plan you select, it is crucial to understand its workings and costs before enrolling.
Most health insurance policies only pay out after their subscribers meet an out-of-pocket expense threshold, known as the deductible, which has now been limited by federal law. Some plans also offer copays and coinsurance fees which subscriber must pay even after meeting the deductible threshold – such as doctor visits or prescription refills.
Some health insurance plans also provide subscribers with access to an in-network provider list at discounted rates, known as in-network providers. You’ll usually be able to find this list either on an insurer website or by contacting them. They should provide you with a Summary of Benefits Coverage document outlining all costs and benefits so you can make an informed decision regarding which coverage options is right for you.
What do I need to know about health insurance?
Finding a plan that meets both your budget and healthcare needs can be tricky. When looking at plans through Health Insurance Marketplaces or employers, be sure to thoroughly assess their costs and benefits before making your choice.
Health insurance coverage can often be obtained through either their employer or through public programs like Medicare or Medi-Cal; but if you’re self-employed, make sure to shop around during open enrollment (or throughout the year) to find the ideal plan for yourself and your circumstances.
Consider which health plan covers your services and includes physicians you want in its provider network before choosing one. Furthermore, think carefully about your budget for monthly payments for such plans, and when and how quickly out-of-pocket costs must be met once your deductible has been reached.
Health care providers must inform you if they’re an in-network or out-of-network provider as well as their fees for services provided. You can check your plan’s provider directory online or ask your physician for a list of in-network providers. NerdWallet is here to help make sense of all the nuances surrounding health insurance, so you can make an informed decision regarding coverage decisions.
How do I shop for health insurance?
The Health Insurance Marketplace provides access to affordable options for individuals and families alike. Shop for plans online, compare costs and coverage options side-by-side and apply during open enrollment or under special circumstances like marriage, birth, job loss or new move to be insured.
Step one in choosing an affordable healthcare plan should be to assess both your healthcare needs and budget. Consider who needs to be covered, when they visit doctors or need care and how frequently. Consider prescription drug coverage, provider networks or any extra benefits as you look for plans with annual deductibles that fit within your budget; this amount represents what must be paid out-of-pocket before the insurance begins paying.
Consider whether you want a health plan that requires you to remain within its network or one that allows you to visit any doctor you desire, and also decide on the types of procedures needed as well as your preferences for primary and specialist physicians who will coordinate care or collaborate on treatment directly.
Pennie can assist you in finding a health plan tailored specifically to your needs and finding one that best meets them. The marketplace allows users to easily compare costs, premiums, deductibles and out-of-pocket maximums so they can make an informed choice about coverage – you can apply online or with an accredited enrollment agent.
