What Is Health Insurance? Coverages and How It Works
Healthcare insurance helps lower the cost of medical expenses in exchange for a regular premium. Read about your options, costs and more.
If you don’t have health insurance through an employer, you have the daunting task of picking a health plan on your own. SmartFinancial can help you understand the health insurance tier system so you’re not comparing apples to oranges when shopping for a plan that’s right for you. Our blog articles are designed to answer all the questions you have about health insurance coverages and out-of-pocket costs. SmartFinancial can also pair you with the right plan based on your profile and budget by comparing all health insurance options in your area.
Healthcare insurance helps lower the cost of medical expenses in exchange for a regular premium. Read about your options, costs and more.
Thanks to the Affordable Care Act (ACA), no one is denied health insurance due to pre-exisitng conditions, such as cancer or diabetes. Before Obamacare, insurance companies used to turn away members with pre-existing conditions due to high costs.
Learn MoreHMOs are typically less expensive than PPO plans, have fewer out-of-pocket costs and have lower deductibles. HMO plans require that you stay within your network for coverage.
Learn MorePPO health plans typically have higher monthly premiums and out-of-pocket expenses but allow for more flexibility in seeing out-of-network doctors without referrals.
Learn MoreA copay is a flat fee paid each time you visit the doctor, pick up a prescription or receive some other type of healthcare service. For example, you may be charged a $50 copay each time you visit your primary care physician and $5 for a prescription drug.
Learn MoreA deductible is a flat fee paid before your healthcare coverage covers your costs. For example: You may be covered for an MRI but have to pay a $60 deductible.
Learn MoreCoinsurance is a percentage of the total cost of services or prescription drug. Some plans have a coinsurance, which you must pay after meeting the deductible.
Learn MoreHealth insurance doesn’t pay for everything. There is a monthly premium that needs to be paid to keep your coverage active. You’ll also have a deductible, copays and sometimes a co-insurance payment. Premiums and copays differ based on each plan and level of coverage.
Learn MoreA health insurance premium must be paid monthly in order to keep coverage active. Certain factors affect premium prices, such as age and location.
Learn MoreThe Affordable Care Act’s health insurance mandate was lifted but the following states still require health insurance to avoid a tax penalty: California, Massachusetts, Washington D.C., New Jersey and Rhode Island. In Vermont, health insurance is required without a penalty.
HMOs generally won't cover out-of-network care, and you’ll need a referral from a primary care physician to see a specialist. A Preferred Provider Organization (PPO) health plan will cover you only partially if you go outside the plan’s network or see a specialist without a referral. An Exclusive Provider Organization (EPO) is a managed care plan that also requires members to use the plan’s network, which is larger than an HMO’s. Premiums cost a bit more than an HMO plan but still less than a PPO plan. In a Point of Service (POS) plan, you pay less if you use health care providers in the plan’s network with a referral from a primary physician to see a specialist. You also pay your medical bills first before filing a claim for reimbursement from the insurance carrier.
Most health insurance plans do not cover optometrist visits and glasses, but you may be covered to see an ophthalmologist, who can take care of eye diseases and write you a prescription for glasses. Your frame and lenses will not be covered unless you have a separate vision plan. Similarly, you may need a separate dental plan for checkups, cleanings and dental work. You may be partially covered for oral surgery with your health insurance plan and partially with your dental insurance plan. You may also need a separate plan for hearing.
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