Health insurance protects you from incurring huge medical bills if you are injured or become sick. It’s a way to pay for healthcare, and purchasing it is mandatory in the United States.
Health insurance is similar to other types of insurance. You choose a plan and pay your premium each month. In return, your health insurance company agrees to pay part of the medical expenses your plan covers.
How People Get Coverage
People obtain health insurance in a variety of ways. Many get coverage through their jobs. Others purchase it through insurance exchanges, services that help people compare and buy health insurance plans. People whose incomes are below certain levels may qualify for Medicaid, and those ages 65 and older can get Medicare.
Those who qualify for Medicare are sometimes surprised to find that a variety of services aren’t covered by the program. For example, Medicare doesn’t cover deductibles or copayments. It also doesn’t cover dental or long-term care, nor does it cover eye exams, hearing aids, or medical care received while traveling outside of the country.
While these medical expenses may seem overwhelming, and they can quickly become so, it’s easy to minimize them. To fill in the gaps, those expenses not covered by Medicare, you can purchase a Medicare Supplement plan.
Medicare Supplement plans cover things like deductibles, copayments, and coinsurance. Some plans also cover expenses like dental visits and hearing aids. When you’re deciding what supplement plan to buy, consider what you want it to cover. For example, some people are fine paying their dental expenses out of pocket while others want coverage.
To purchase a plan, most people start their search online. Choosing the right supplemental Medicare insurance isn’t always easy, so don’t hesitate to ask for help. Picking a plan is an important decision, and you want to make sure you choose correctly the first time.
What Health Insurance Covers
Most health insurance plans cover 100 percent of preventative care even if you haven’t met your deductible. Preventative care includes some health care screenings and vaccinations. If you’re unsure what is considered preventative care, check your policy before your appointment, but screenings like well-baby visits, mammograms for women over 40, and colonoscopies for people between 50 and 75 are usually considered preventative care.
Most plans also cover the 10 essential health benefits required by the Affordable Care Act. These 10 health benefits include:
- Pediatric Services
- Prescription Drugs
- Laboratory Services
- Emergency Services
- Maternity and Newborn Care
- Rehabilitative Services
- Mental Health Services
- Preventative Services
- Ambulatory Patient Services
Most insurance plans cover these services, but you must first meet your deductible, if you have one, before your insurance company will pay for them. A copayment is often required even if you’ve met your deductible.
The payments your insurance company makes to your health care providers are based on discounts they negotiate with them. This discount is passed on to you. Even if you haven’t met your deductible for the year, you pay the negotiated rate. This rate is almost always cheaper than what an uninsured patient pays.
Americans are required by law to have health insurance. Anyone that can afford to purchase coverage but doesn’t is subject to a fine. The penalty is $695 per adult and $347.50 per child with a maximum of $2085 per family, or 2.5 percent of household income, whichever is more. Additionally, the IRS will not process any electronically filed return that doesn’t include proof of health insurance, meaning people without coverage will have to file a paper return.
Exemptions from the law are available. If you can prove you can’t afford coverage, you won’t have to pay a fine. Some qualifying exemptions include homelessness, large medical debt, or a death in the family.
Health insurance covers expenses you may incur due to illness, accident, or other conditions. It keeps you from incurring huge medical bills, and you are legally required to purchase it. While it isn’t always easy to find a plan that’s right for you, health insurance grants you peace of mind and protects you from financial ruin in the event of a medical catastrophe.