One of the most expensive costs families take on in the United States are those tied to major medical issues.
While even preventative healthcare can add up, having health insurance is a requisite coverage which can help you pay for unwanted and untimely bills.
What is Health Insurance?
Health insurance is the most common type of personal insurance where a contract where your insurer pays some or all of your medical costs for a premium.
It can cover:
- doctor visits
- lab work
- dental care
- drug prescriptions
- other costs
In many cases, it is provided by employers.
It is important to have health insurance because medical bills can cripple your finances, especially in an emergency. Picking a health insurance plan can feel like a pain because there is a variety of restrictions for each plan.
It is too easy to skimp on a health plan, but understanding what your options cover will save you from surprising expenses later.
What It Can Cover?
Health insurance can cover any medical cost which is approved on your policy. Visits to the doctor, medication, eye exams, and mental health services are examples of what your insurance might cover.
It may also cover children, up to a certain age.
They often have deductibles and copays. Copays are set fees patients must pay for services, and deductibles are the amount they will pay annually before the insurance covers anything.
Paying a higher premium tends to result in lower deductibles and copays, where paying less on a monthly basis may mean additional copays and a higher deductible.
What Does It Not Cover?
Treatment and services not mentioned in the policy may not be covered, especially if it is outside of your provider’s network.
If they do, you may have to pay a higher percentage of the costs.
Preauthorization is required for certain services on your policy. It’s best to check with the insurance company before incurring major expenses.
In general, cheaper insurance plans tend to have more out-of-pocket expenses.
Under the Affordable Health Care Act, insurance companies cannot deny coverage on the basis of a preexisting condition.
Are There Any Policy Limits?
Yes, there are. Insurers can deny coverage to brand name medications if a generic version is available at a lower cost.
They also tend not to cover:
- Cosmetic procedures
- Beauty treatments
- New technologies
- Fertility treatments
Insurance companies may have exceptions for specific cases.
Oftentimes, the patient’s doctor may have to give a basis for the procedure being more beneficial. Other times, you may have to appeal the denial. The insurance company is required to let you know its procedures for an appeal.
If you are rejected again, you may have your case reviewed by your state’s insurance commissioner. This usually doesn’t cost anything to do.
It is important to know what’s in your insurance plan, so you can pick your doctor and avoid surprise expenses.
Your health is the most important thing you can insure, so it’s worth shopping around for a good plan.