A Quick Guide to Health Insurance

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After the Affordable Care Act was passed, all American citizens are required to have health insurance. The costs of medical bills and services can get out of control very easily, and you never know when a medical emergency could happen. There are a lot of options out there for plans and coverage; it can get very overwhelming. Here is a quick guide to health insurance so that you can make the right choice for you.

Some Basic Terminology

Like auto and home insurance, health insurance will not cover everything. It is designed to help share the costs that you have. There are five key features that will decide how much you will pay and how much your insurance will cover. They are: your premium, your copayment, your deductible, your coinsurance and your out-of-pocket limit.

Your premium is basically a monthly bill that gives you access to your plan. Your copayment is a predetermined amount that you will pay for a covered service. Depending on your plan, they can take effect before or after your deductible.

Your deductible is another predetermined amount that you contribute to your health care costs before your insurance starts to help out. Coinsurance is what you pay after you have reached your deductible. It is usually a percentage amount of the services.

Your out-of-pocket limit is the limit set in place for you to spend on deductibles, copayments and coinsurance before the insurance will start to cover those as well.

The 10 Essential Benefits

Following the Affordable Care Act, there are now 10 essential benefits that every health insurance policy must cover. Regardless of your plan that you choose, these are required to be covered by health insurance. Services beyond these 10 can be covered through additional insurance coverage. The 10 essential benefits provided on Healthcare.gov and are:

  • Emergency services
  • Pregnancy, maternity and newborn care
  • Preventive and wellness services, which includes chronic disease management
  • Outpatient care (also known as Ambulatory patient services)
  • Hospitalization for overnight stays, surgeries and other conditions
  • Rehabilitative and habilitative services and devices
  • Prescription drugs
  • Mental health and substance use disorder services
  • Laboratory services (i.e. blood work)
  • Pediatric services, which includes vision and dental services for children

Getting the Coverage Right for You

With the many plans out there, it is important to do your research. Getting quotes from a few companies is a good place to start. Be aware of a few misconceptions when doing your research. Just because a policy has a low premium, that doesn’t mean that it will have the least overall costs. Normally the way that is goes is that a low premium policy will have a higher deductible and vice-versa. Take into account your personal health care needs, there may be services not covered by the 10 essential benefits you will need. Most of these additional services can be covered through additional plans.

This is a guest post contributed by InPro Insurance Group, an insurance firm based out of Troy, Michigan.