One of the greatest pieces of advice known to man is, that while you enjoy your good health, keep your health insurance plan somewhere around. Likewise, this advice will certainly be beneficial to anyone with a preexisting condition. Now, this does not apply to just one person, an entire family should all get coverage for their health.
Health insurance coverage makes it easier to navigate all the health challenges that may come your way. More so, there are lots of companies selling health insurance plans that you can choose from. But before you settle down with one, do well to check with others.
Also, be wise enough to have all you want under your coverage plan at an affordable rate. So, without further ado, let’s talk more about health insurance coverage.
What is Health Insurance?
Moving on, Health insurance is the coverage that financially covers all or most of your medical bills. Also, this might include surgeries and/or dental services. That means, that when you need medical attention, the health insurance company takes up the financial costs.
Your health policy is not the kind of insurance you can rush over. There are things about it that you just have to sit down and intently consider before you conclude on it. Additionally, most health insurance companies are attached to a health care facility or a hospital where their consumers can get medical assistance.
So, some companies frown when their consumers use other non-designated medical services. Not just that but also going for medical services without their permission, the kinds of drugs a consumer takes from the hospital. The reason why it is important to ask your provider company their rules for each plan before you go in fully.
What to expect in Health Insurance Plans
Basically, there are quite a number of things you should know about most health coverage plans. These things are mostly what is required from any would-be health insurance consumer and these are called Copays, deductibles, out-of-pocket, and coinsurance.
Copays
Now, a copay is like a fixed amount of money you put down on the spot in the hospital for medical service as a health insurance consumer. This payment will cover whatever reason that took you to the hospital. Maybe for a check-up or for refilling prescribed drugs. So, this down payment is what is called a copay or copayment.
Is Copayment a permanent thing?
Well, copays are a constant part of some health care coverage plans and are mostly less or just $25 per hospital visit. It is possible for these fees to change annually, so always stay updated with your provider. Meanwhile, some other plans do not require a copay at all while others require both copays and deductibles. Just be sure to know the type of coverage you are paying for. However, if you use your provider’s in-network health care services, you will always pay a very low amount in copays.
Deductibles
Also, deductibles are another type of payment you make for your medical services from your own pocket. Deductibles are yearly payments for your medical expenses before your coverage plan kicks in to share in the cost of your medical expenses. Again, there are types of deductibles available for anyone that is looking to buy coverage. Deductibles for individual coverage are different from deductibles for family coverage.
Furthermore, the best coinsurance plan for you and your family is one that can pay for a higher percentage of costs. That is a plan with a lower deductible and higher premium package that will cover more medical expenses.
Between Copayments and Deductibles
Firstly, copays are a fixed amount you pay for each visit to the hospital or for a refill of your prescription. Deductibles are the yearly amounts you pay for your medical expenses.
Secondly, copays are much cheaper so they are $25 or less for each hospital visit. Deductibles are a larger amount of funds you pay yearly as a health care consumer before your provider steps in to pay a claim. Conclusively, your copay is a step towards meeting your deductibles. And all these depend on your provider and the type of coverage plan you use.
Coinsurance
Coinsurance is another kind of money you pay for your medical fees, even after paying for deductibles. Ultimately, your health insurance provider pays a part of your medical expenses, while you pay some part too. Like, in simpler terms, you share your medical expenses payment with your health insurance provider. This may come in form of 20% against the remaining 80%. So, your provider foots the 80% while you, the 20%. importantly, the amount you pay as coinsurance depends on your coverage plan. With the higher coinsurance you have, the higher amount you get to pay.
Copayments, Deductibles, and Coinsurance
For more clarification, copayments are fixed dollars you pay every time you visit the hospital for a health check or for a prescription refill.
Deductibles are the yearly medical expenses you must pay before your provider steps in.
Coinsurance payments are the percentage of your medical expenses you share with your provider. You get to pay the lower percentage and your provider pays the higher percentage.
Out-of-Pocket Maximum
This here is the highest monies you spent in copays, deductibles, and coinsurance to cover your medical expenses in a full year. By the way, there is a certain maximum you must also get to before your company steps in. Once you get to the maximum of your out-of-pocket, your health care company will step in and pay for all your medical bills for the rest of the year. Meanwhile, every health insurance company has a way they handle their out-of-pockets and the maximum payments involved. But you must use the in-network health care services.
Health insurance options
While it is important to have health insurance coverage for yourself and your family, it might be expensive. Families or individuals with low income may not be able to afford these providers. However, there is a subsidized way for all to get that adequate health coverage, regardless of income. This is through the Affordable Care Act (ACA), Medicaid, Medicare, and Children’s Health Insurance Program (CHIP).
- Affordable Care Act (ACA)
Often called Obama Care because the former U.S president signed it into law in 2023. This Act helped uninsured Americans get access to health insurance. It expanded the eligibility for American citizens to get Medicaid and also stopped insurance companies from denying people coverage. It was in the favor of low-income families.
- Medicaid
Medicaid is a program by the United States government. This program provides for low-income citizens and gives benefits that are not accessible or not covered by Medicare. Also, it covers the health care of low-income citizens.
- Medicare
Medicare takes care of elderly citizens and provides health care insurance coverage for them.
- Children’s Health Insurance Program (CHIP)
CHIP offers low-cost health insurance coverage for children from families that earn high enough to qualify for Medicaid but do not earn enough to purchase private insurance plans. This program also covers pregnant women.
