Understanding Health Insurance

Insurance Basics

Most people get health insurance through a job-based health plan, or they buy it themselves from an insurance company.

If you have to buy insurance on your own, many kinds of private health insurance policies are for sale. Different kinds of policies can offer very different kinds of benefits and can limit your access to some doctors, hospitals, or other providers.

The kinds of benefits and which care providers your policy covers can make a big difference in your costs and the quality of care you get if you become ill.

Source: Medicare.gov

How much will my policy cost me?

The answer is more complicated than you might think. The cheapest policy may not provide you the best overall value.

The most obvious feature of any policy is the premium – the amount you pay (usually monthly) to an insurance company for a health insurance policy.

Just as important as the premium cost, however, is how much you have to pay when you get services. Examples include:

  • How much you pay before insurance coverage begins (a deductible)
  • What you pay for services after you pay the deductible
  • How much in total you will have to pay if you get sick (the out-of-pocket maximum)

Often, there is a direct tradeoff between how much you pay for health insurance and the extent of the covered benefits.

As you weigh this tradeoff, remember that buying the policy with the cheapest premium or with a very high out-of-pocket maximum may leave many services and treatments uncovered. This could leave you vulnerable to high medical bills.

Private health insurance plans often have networks of hospitals, doctors, specialists, pharmacies, and other health care providers. Networks include health care providers that have a contract with an insurer to take care of the plan’s members.

When choosing a plan, review the list of providers that give care under the policy. If staying with your current doctors is important to you, check to see if they are included.

Depending on the type of policy you buy, care may be covered only when received from a network provider.  To get care from a specialist you may need a referral from your primary care doctor.

Types of plans and network restrictions

How do I know if my plan’s network includes high quality doctors and hospitals?

Ask your doctor to see if the plan’s list of specialists include other respected doctors–such as cardiologists, surgeons, and oncologists–even if you may not need them today, as another way of understanding the protection the health plan offers.

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